SUSAN KAY MANTELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

KAY

Last Name

MANTELL

Suffix

Business Name

SUSAN KAY MANTELL MD

Original Issue Date

10/19/2006

Effective Date

10/19/2006

Expiration Date

07/31/2008

City

PHILO

State

Zip

61864

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020