PANJAPORN SUPANWANID MD - Medical Doctor License in Illinois | # 33*****64

PANJAPORN SUPANWANID MD

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

ACTIVE

Business

N

First Name

PANJAPORN

Last Name

SUPANWANID

Suffix

MD

Business Name

PANJAPORN SUPANWANID MD

Original Issue Date

03/21/2008

Effective Date

04/19/2023

Expiration Date

07/31/2026

City

CHICAGO

State

IL

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

04/19/2023