MICHAEL THOMAS AMBROSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

THOMAS

Last Name

AMBROSE

Suffix

Business Name

MICHAEL THOMAS AMBROSE MD

Original Issue Date

12/12/2014

Effective Date

12/12/2014

Expiration Date

07/31/2017

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020