MARTIN I ELLENBY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

ACTIVE

Business

First Name

MARTIN I

Last Name

ELLENBY

Suffix

Business Name

MARTIN I ELLENBY MD

Original Issue Date

08/11/1988

Effective Date

04/09/2023

Expiration Date

07/31/2026

City

CHICAGO RIDGE

State

Zip

60415

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/09/2023