DITTANA PHONCHAROENSRI Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

DITTANA

Last Name

PHONCHAROENSRI

Business Name

DITTANA PHONCHAROENSRI

Original Issue Date

12/31/2008

Effective Date

12/31/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011