TRAVIS MARK AMENGUAL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

ACTIVE

Business

First Name

TRAVIS

Middle

MARK

Last Name

AMENGUAL

Business Name

TRAVIS MARK AMENGUAL

Original Issue Date

07/13/2020

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023