MARK S AMBROSE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000830

License Status

ACTIVE

Business

First Name

MARK

Middle

Last Name

AMBROSE

Business Name

MARK S AMBROSE

Original Issue Date

01/06/1997

Effective Date

12/04/2025

Expiration Date

03/01/2028

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Ever Disciplined

LastModifiedDate

12/04/2025