GEOFFREY RUSSELL DETOLVE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036054087

License Status

INACTIVE

Business

First Name

GEOFFREY RUSSELL

Last Name

DETOLVE

Suffix

Business Name

GEOFFREY RUSSELL DETOLVE MD

Original Issue Date

01/13/1977

Effective Date

01/13/1977

Expiration Date

07/31/1996

City

PORTAGE

State

Zip

49024

County

MICHIGAN

Ever Disciplined

LastModifiedDate

09/20/2006