KAVITHA SUSAN JACOB MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

ACTIVE

Business

Title

First Name

KAVITHA

Middle

SUSAN

Last Name

JACOB

Business Name

KAVITHA SUSAN JACOB MD

Original Issue Date

08/30/2018

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023