INGA CHARISSE FORDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

Title

First Name

INGA

Middle

CHARISSE

Last Name

FORDE

Business Name

INGA CHARISSE FORDE MD

Original Issue Date

06/29/2011

Effective Date

05/16/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60654

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017