CHARLOTTE LOUISE ELLENBOGEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036111509

License Status

NOT RENEWED

Business

First Name

CHARLOTTE

Middle

LOUISE

Last Name

ELLENBOGEN

Suffix

Business Name

CHARLOTTE LOUISE ELLENBOGEN DO

Original Issue Date

05/28/2004

Effective Date

05/16/2011

Expiration Date

07/31/2014

City

BURR RIDGE

State

Zip

60527

County

DUPAGE

Ever Disciplined

LastModifiedDate

11/17/2014