EMILY MARIE FUKUDA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****28

License Status

ACTIVE

Business

First Name

EMILY

Middle

MARIE

Last Name

FUKUDA

Business Name

EMILY MARIE FUKUDA

Original Issue Date

12/31/2020

Effective Date

01/16/2024

Expiration Date

03/01/2026

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025