MACEO RUSSELL ELLISON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

MACEO RUSSELL

Last Name

ELLISON

Suffix

Business Name

MACEO RUSSELL ELLISON MD

Original Issue Date

01/01/1997

Effective Date

06/09/2014

Expiration Date

07/31/2017

City

CAROL STREAM

State

Zip

60188

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020