PENPORN VONGSVIVUT RECK MD - Medical Doctor License in Illinois | # 33*****40

PENPORN VONGSVIVUT RECK MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

N

First Name

PENPORN

Middle

VONGSVIVUT

Last Name

RECK

Suffix

MD

Business Name

PENPORN VONGSVIVUT RECK MD

Original Issue Date

06/12/2006

Effective Date

06/12/2006

Expiration Date

07/31/2008

City

CHICAGO

State

IL

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

11/06/2008