TIFFANY NICOLE SUZANNE BALLARD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036143221

License Status

NOT RENEWED

Business

Title

First Name

TIFFANY

Middle

NICOLE SUZANNE

Last Name

BALLARD

Business Name

TIFFANY NICOLE SUZANNE BALLARD MD

Original Issue Date

05/17/2017

Effective Date

05/17/2017

Expiration Date

09/30/2020

City

ANN ARBOR

State

Zip

48105

Ever Disciplined

LastModifiedDate

01/14/2021