MICHAEL D STORMONT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000953

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

Last Name

STORMONT

Business Name

MICHAEL D STORMONT

Original Issue Date

12/19/1997

Effective Date

12/19/1997

Expiration Date

03/01/2004

City

MONROE

State

Zip

53566

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006