CHARLOTTE LOUISE ELLENBOGEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

CHARLOTTE

Middle

LOUISE

Last Name

ELLENBOGEN

Suffix

Business Name

CHARLOTTE LOUISE ELLENBOGEN DO

Original Issue Date

06/08/2004

Effective Date

05/16/2011

Expiration Date

07/31/2014

City

BURR RIDGE

State

Zip

60527

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014