DAVID JOSEPH POLIDORI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

CANCELLED

Business

First Name

DAVID

Middle

JOSEPH

Last Name

POLIDORI

Suffix

Business Name

DAVID JOSEPH POLIDORI MD

Original Issue Date

11/07/2001

Effective Date

11/07/2001

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006