ETHAN MICHAEL MEISEL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

ETHAN

Middle

MICHAEL

Last Name

MEISEL

Suffix

Business Name

ETHAN MICHAEL MEISEL MD

Original Issue Date

06/19/2009

Effective Date

04/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

I II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021