MADISON SAMPLE JR Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093157

License Status

ACTIVE

Business

First Name

MADISON

Last Name

SAMPLE JR

Business Name

MADISON SAMPLE JR

Original Issue Date

06/11/1996

Effective Date

09/12/2023

Expiration Date

07/31/2026

City

BURR RIDGE

State

Zip

60527

County

DUPAGE

Ever Disciplined

LastModifiedDate

03/10/2026

Case Number

2025006682

Action

Suspension

Discipline Start Date

09/08/2025

Discipline Reason

Failure to file and/or pay Illinois state income taxes.