SUSAN KAY MANTELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

KAY

Last Name

MANTELL

Suffix

Business Name

SUSAN KAY MANTELL MD

Original Issue Date

10/29/2004

Effective Date

06/04/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020