MONTHA SUPHANGUL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

ACTIVE

Business

First Name

MONTHA

Last Name

SUPHANGUL

Suffix

Business Name

MONTHA SUPHANGUL MD

Original Issue Date

08/27/2008

Effective Date

04/29/2023

Expiration Date

07/31/2026

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/29/2023