MICHAEL ANDREW SULLIVAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****85

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

ANDREW

Last Name

SULLIVAN

Business Name

MICHAEL ANDREW SULLIVAN

Original Issue Date

11/12/2004

Effective Date

11/12/2004

Expiration Date

03/01/2008

City

DES PLAINES

State

Zip

60016

County

COOK

Ever Disciplined

LastModifiedDate

01/24/2007