ANDREW PAUL RUSSEAU MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065508

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

PAUL

Last Name

RUSSEAU

Business Name

ANDREW PAUL RUSSEAU MD

Original Issue Date

06/23/2017

Effective Date

06/23/2017

Expiration Date

06/22/2019

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

04/10/2017