CHANG KI SONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

NOT RENEWED

Business

First Name

CHANG KI

Last Name

SONG

Suffix

Business Name

CHANG KI SONG MD

Original Issue Date

01/01/1997

Effective Date

05/23/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61615

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014