MATTHEW DAVID ETTLESON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

ACTIVE

Business

Title

First Name

MATTHEW

Middle

DAVID

Last Name

ETTLESON

Business Name

MATTHEW DAVID ETTLESON MD

Original Issue Date

06/07/2021

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023