MICHAEL THOMAS AMBROSE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

THOMAS

Last Name

AMBROSE

Suffix

Business Name

MICHAEL THOMAS AMBROSE MD

Original Issue Date

06/29/2011

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023