S SUWATANA PONGCHED MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

CANCELLED

Business

First Name

S SUWATANA

Last Name

PONGCHED

Suffix

Business Name

S SUWATANA PONGCHED MD

Original Issue Date

01/12/1993

Effective Date

06/22/2011

Expiration Date

07/31/2014

City

FOREST PARK

State

Zip

60130

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014