NICHOLAS DEAN POULOS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

NICHOLAS DEAN

Last Name

POULOS

Suffix

Business Name

NICHOLAS DEAN POULOS MD

Original Issue Date

06/23/1994

Effective Date

05/09/2019

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021