GRACE MURICKEN THUNDIYIL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

GRACE

Middle

MURICKEN

Last Name

THUNDIYIL

Suffix

Business Name

GRACE MURICKEN THUNDIYIL MD

Original Issue Date

05/23/1988

Effective Date

05/23/1988

Expiration Date

07/31/2002

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017