MARK EDWARD RUSSO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066950

License Status

EXPIRED

Business

Title

First Name

MARK

Middle

EDWARD

Last Name

RUSSO

Business Name

MARK EDWARD RUSSO MD

Original Issue Date

06/23/2015

Effective Date

06/23/2015

Expiration Date

06/22/2016

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

08/16/2016