ANN L MELLOTT Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

First Name

ANN L

Last Name

MELLOTT

Business Name

ANN L MELLOTT

Original Issue Date

12/09/1998

Effective Date

12/17/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017