SAMUEL DAVID FAM DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151191

License Status

ACTIVE

Business

Title

First Name

SAMUEL

Middle

DAVID

Last Name

FAM

Business Name

SAMUEL DAVID FAM DO

Original Issue Date

11/13/2019

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60602

Ever Disciplined

LastModifiedDate

07/19/2023