LEE MICHAEL PERIOLAT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036046764

License Status

NOT RENEWED

Business

First Name

LEE MICHAEL

Last Name

PERIOLAT

Suffix

Business Name

LEE MICHAEL PERIOLAT MD

Original Issue Date

01/23/1973

Effective Date

01/23/1973

Expiration Date

07/31/1990

City

VALPARAISO

State

Zip

46383

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006