KIRK SHANE RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036132698

License Status

NOT RENEWED

Business

Title

First Name

KIRK

Middle

SHANE

Last Name

RUSSELL

Business Name

KIRK SHANE RUSSELL MD

Original Issue Date

05/01/2013

Effective Date

05/01/2013

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014