CHARLES VAN CLEVENGER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

CHARLES

Middle

VAN

Last Name

CLEVENGER

Suffix

Business Name

CHARLES VAN CLEVENGER MD

Original Issue Date

07/05/2007

Effective Date

04/18/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

IV V

Ever Disciplined

LastModifiedDate

11/17/2014