THEODORE S INGRASSIA III MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

First Name

THEODORE S

Last Name

INGRASSIA III

Suffix

Business Name

THEODORE S INGRASSIA III MD

Original Issue Date

01/31/1992

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023