TIMOTHY J RUSSELL DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015040

License Status

EXPIRED

Business

First Name

TIMOTHY J

Last Name

RUSSELL

Suffix

Business Name

TIMOTHY J RUSSELL DO

Original Issue Date

10/18/1982

Effective Date

10/18/1982

Expiration Date

10/14/1984

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006