WONIL TAE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

ACTIVE

Business

Title

First Name

WONIL

Last Name

TAE

Business Name

WONIL TAE MD

Original Issue Date

07/25/2008

Effective Date

06/07/2023

Expiration Date

07/31/2026

City

ALTON

State

Zip

62002

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/07/2023