MARGO AIDAN GROMOLL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

NOT RENEWED

Business

Title

First Name

MARGO

Middle

AIDAN

Last Name

GROMOLL

Business Name

MARGO AIDAN GROMOLL MD

Original Issue Date

07/07/2010

Effective Date

07/07/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014