SUPORN PONGLORPISIT MD - Medical Doctor License in Illinois | # 036053480

SUPORN PONGLORPISIT MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036053480

License Status

NOT RENEWED

Business

N

First Name

SUPORN

Last Name

PONGLORPISIT

Suffix

MD

Business Name

SUPORN PONGLORPISIT MD

Original Issue Date

08/25/1976

Effective Date

06/14/2017

Expiration Date

09/30/2020

City

HIGHLAND PARK

State

IL

Zip

60035

County

LAKE

Ever Disciplined

N

LastModifiedDate

01/14/2021