MARIE M SULLIVAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

CANCELLED

Business

First Name

MARIE

Middle

Last Name

SULLIVAN

Suffix

Business Name

MARIE M SULLIVAN MD

Original Issue Date

08/27/2004

Effective Date

08/27/2004

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61636

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2008