STACEY ELLEN BAN Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108968

License Status

ACTIVE

Business

First Name

STACEY

Middle

ELLEN

Last Name

BAN

Business Name

STACEY ELLEN BAN

Original Issue Date

04/08/2003

Effective Date

06/21/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60631

County

LAKE

Ever Disciplined

LastModifiedDate

06/21/2023