EDWARD JOHN SUPAN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007043

License Status

ACTIVE

Business

First Name

EDWARD

Middle

JOHN

Last Name

SUPAN

Business Name

EDWARD JOHN SUPAN

Original Issue Date

04/19/2019

Effective Date

01/08/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60634

County

COOK

Ever Disciplined

LastModifiedDate

01/08/2026