TODD W BANNEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

ACTIVE

Business

First Name

TODD

Middle

Last Name

BANNEN

Suffix

Business Name

TODD W BANNEN MD

Original Issue Date

01/12/1999

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

BARRINGTON

State

Zip

60010

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/13/2023