GRACE CONANT BANNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

ACTIVE

Business

Title

First Name

GRACE

Middle

CONANT

Last Name

BANNER

Business Name

GRACE CONANT BANNER MD

Original Issue Date

04/26/2017

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023