MARK S AMBROSE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****47

License Status

ACTIVE

Business

First Name

MARK

Middle

Last Name

AMBROSE

Business Name

MARK S AMBROSE

Original Issue Date

03/12/2001

Effective Date

12/04/2025

Expiration Date

03/01/2028

City

GLEN ELLYN

State

Zip

60137

County

COOK

Ever Disciplined

LastModifiedDate

12/04/2025