IMO A EBONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

NOT RENEWED

Business

First Name

IMO

Middle

Last Name

EBONG

Suffix

Business Name

IMO A EBONG MD

Original Issue Date

04/04/2018

Effective Date

04/04/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021