ELYSE NICOLE FULTS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

ACTIVE

Business

Title

First Name

ELYSE

Middle

NICOLE

Last Name

FULTS

Business Name

ELYSE NICOLE FULTS MD

Original Issue Date

07/03/2023

Effective Date

07/03/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/03/2023