EDWARD JOHN SUPAN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****08

License Status

ACTIVE

Business

First Name

EDWARD

Middle

JOHN

Last Name

SUPAN

Business Name

EDWARD JOHN SUPAN

Original Issue Date

08/12/2019

Effective Date

01/08/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60611

County

HENRY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/08/2026