MICHELLE L ROTH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

ACTIVE

Business

First Name

MICHELLE

Middle

Last Name

ROTH

Business Name

MICHELLE L ROTH

Original Issue Date

09/19/2007

Effective Date

01/13/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61614

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/13/2026