MICHAEL ISAAC ELLENBOGEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

Title

First Name

MICHAEL

Middle

ISAAC

Last Name

ELLENBOGEN

Business Name

MICHAEL ISAAC ELLENBOGEN MD

Original Issue Date

03/07/2014

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021