MATTHEW DAVID ETTLESON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

Title

First Name

MATTHEW

Middle

DAVID

Last Name

ETTLESON

Business Name

MATTHEW DAVID ETTLESON MD

Original Issue Date

04/17/2019

Effective Date

04/17/2019

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021