BRIDGET SUSAN BANACH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

ACTIVE

Business

Title

First Name

BRIDGET

Middle

SUSAN

Last Name

BANACH

Business Name

BRIDGET SUSAN BANACH MD

Original Issue Date

02/11/2015

Effective Date

04/24/2023

Expiration Date

07/31/2026

City

GENEVA

State

Zip

60134

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/24/2023