ETHEL SUSAN HERSKOVIC DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053522

License Status

CANCELLED

Business

Title

First Name

ETHEL

Middle

SUSAN

Last Name

HERSKOVIC

Business Name

ETHEL SUSAN HERSKOVIC DO

Original Issue Date

08/18/2010

Effective Date

08/18/2010

Expiration Date

08/17/2012

City

EDEN PRAIRIE

State

Zip

55344

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

08/10/2010