ARIELLE NICOLE PORT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

ACTIVE

Business

Title

First Name

ARIELLE

Middle

NICOLE

Last Name

PORT

Business Name

ARIELLE NICOLE PORT MD

Original Issue Date

04/12/2017

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023