TIFFANY NICOLE SUZANNE BALLARD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

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

County

MICHIGAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021