SUSAN R RUSSELL Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048026

License Status

EXPIRED

Business

First Name

SUSAN

Middle

Last Name

RUSSELL

Business Name

SUSAN R RUSSELL

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2007

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

07/03/2007