ELLEN JO GUSTAFSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

ACTIVE

Business

First Name

ELLEN

Middle

Last Name

GUSTAFSON

Suffix

Business Name

ELLEN JO GUSTAFSON MD

Original Issue Date

05/01/2003

Effective Date

05/02/2023

Expiration Date

07/31/2026

City

JOLIET

State

Zip

60435

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2023