STACEY ELLEN BAN 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

First Name

STACEY

Middle

ELLEN

Last Name

BAN

Business Name

STACEY ELLEN BAN

Original Issue Date

12/27/2004

Effective Date

08/02/2017

Expiration Date

09/30/2020

City

DEERFIELD

State

Zip

60015

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021