ELLY BUDIMAN-MAK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

First Name

ELLY

Last Name

BUDIMAN-MAK

Suffix

Business Name

ELLY BUDIMAN-MAK MD

Original Issue Date

06/24/1991

Effective Date

05/09/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60605

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

04/05/2020