ELLEN D WALTHALL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

First Name

ELLEN D

Last Name

WALTHALL

Suffix

Business Name

ELLEN D WALTHALL MD

Original Issue Date

09/01/1995

Effective Date

09/01/1995

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006