STACEY ELLEN BAN Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

ACTIVE

Business

First Name

STACEY

Middle

ELLEN

Last Name

BAN

Business Name

STACEY ELLEN BAN

Original Issue Date

07/14/2024

Effective Date

07/14/2024

Expiration Date

07/31/2026

City

DEERFIELD

State

Zip

60015

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026