MACEO RUSSELL ELLISON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

MACEO RUSSELL

Last Name

ELLISON

Suffix

Business Name

MACEO RUSSELL ELLISON MD

Original Issue Date

05/01/1986

Effective Date

05/01/1986

Expiration Date

07/31/1990

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020