LARA MASULLO ELLISON DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036114549

License Status

ACTIVE

Business

First Name

LARA

Middle

MASULLO

Last Name

ELLISON

Suffix

Business Name

LARA MASULLO ELLISON DO

Original Issue Date

09/02/2005

Effective Date

07/05/2023

Expiration Date

07/31/2026

City

NAPERVILLE

State

Zip

60564

County

WILL

Ever Disciplined

LastModifiedDate

07/05/2023