SUPORN PONGLORPISIT MD - Medical Doctor License in Illinois | # 33*****15

SUPORN PONGLORPISIT MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

N

First Name

SUPORN

Last Name

PONGLORPISIT

Suffix

MD

Business Name

SUPORN PONGLORPISIT MD

Original Issue Date

01/01/1997

Effective Date

06/14/2017

Expiration Date

09/30/2020

City

HIGHLAND PARK

State

IL

Zip

60035

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

01/14/2021