MARIE ELLEN ELLIS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075136

License Status

CANCELLED

Business

Title

First Name

MARIE

Middle

ELLEN

Last Name

ELLIS

Business Name

MARIE ELLEN ELLIS DO

Original Issue Date

06/25/2019

Effective Date

06/25/2019

Expiration Date

06/24/2022

City

CHICAGO

State

Zip

60617

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/10/2019