GEORGE RONEN NISSAN DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

First Name

GEORGE

Middle

RONEN

Last Name

NISSAN

Suffix

Business Name

GEORGE RONEN NISSAN DO

Original Issue Date

02/06/2003

Effective Date

10/16/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60642

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/16/2023