DAVID L ELLENS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028566

License Status

EXPIRED

Business

First Name

DAVID L

Last Name

ELLENS

Business Name

DAVID L ELLENS

Original Issue Date

06/03/1992

Effective Date

06/03/1992

Expiration Date

06/30/1995

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006