MARYANN KURUVILLA JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036109150

License Status

NOT RENEWED

Business

First Name

MARYANN

Middle

KURUVILLA

Last Name

JACOB

Suffix

Business Name

MARYANN KURUVILLA JACOB MD

Original Issue Date

05/01/2003

Effective Date

05/01/2003

Expiration Date

07/31/2005

City

TROY

State

Zip

48084

County

MICHIGAN

Ever Disciplined

LastModifiedDate

10/09/2006