TRACEY M DAVENPORT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

ACTIVE

Business

First Name

TRACEY

Middle

Last Name

DAVENPORT

Suffix

Business Name

TRACEY M DAVENPORT MD

Original Issue Date

08/10/2005

Effective Date

05/06/2023

Expiration Date

07/31/2026

City

OAK PARK

State

Zip

60302

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/06/2023