GRACE BOLANLE AYANDIBU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

ACTIVE

Business

Title

First Name

GRACE

Middle

BOLANLE

Last Name

AYANDIBU

Business Name

GRACE BOLANLE AYANDIBU MD

Original Issue Date

08/22/2022

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023