INGRID C ANTONSEN MD 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

INGRID C

Last Name

ANTONSEN

Suffix

Business Name

INGRID C ANTONSEN MD

Original Issue Date

09/26/1988

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021