DALE J ELLENBERG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

First Name

DALE J

Last Name

ELLENBERG

Suffix

Business Name

DALE J ELLENBERG MD

Original Issue Date

11/10/1982

Effective Date

11/10/1982

Expiration Date

07/31/1984

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006