ELLEN SONG MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

ACTIVE

Business

Title

First Name

ELLEN

Last Name

SONG

Business Name

ELLEN SONG MD

Original Issue Date

09/15/2023

Effective Date

09/15/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/15/2023