NISSIM GEDALIAH STOLBERG DO 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

NISSIM

Middle

GEDALIAH

Last Name

STOLBERG

Business Name

NISSIM GEDALIAH STOLBERG DO

Original Issue Date

05/26/2021

Effective Date

04/16/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/16/2023