JANTZEN MICHELLE PRIDE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083617

License Status

ACTIVE

Business

Title

First Name

JANTZEN

Middle

MICHELLE

Last Name

PRIDE

Business Name

JANTZEN MICHELLE PRIDE MD

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2027

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/12/2024