ANNA MICHELLE EDMISTON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

Title

First Name

ANNA

Middle

MICHELLE

Last Name

EDMISTON

Business Name

ANNA MICHELLE EDMISTON MD

Original Issue Date

07/26/2018

Effective Date

07/26/2018

Expiration Date

09/30/2020

City

ANTIOCH

State

Zip

60002

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021