NICOLAAS MICHAEL JONGERIUS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

NICOLAAS MICHAEL

Last Name

JONGERIUS

Suffix

Business Name

NICOLAAS MICHAEL JONGERIUS MD

Original Issue Date

07/31/1990

Effective Date

12/08/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021