STEPHANIE NEWVILLE GARDON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

Title

First Name

STEPHANIE

Middle

NEWVILLE

Last Name

GARDON

Business Name

STEPHANIE NEWVILLE GARDON MD

Original Issue Date

05/10/2012

Effective Date

05/10/2012

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020