LISA M FORTMAN Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

ACTIVE

Business

First Name

LISA

Middle

Last Name

FORTMAN

Business Name

LISA M FORTMAN

Original Issue Date

11/01/1991

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

HINSDALE

State

Zip

60521

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023