SAMUEL GUY RUSSELL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071153

License Status

CANCELLED

Business

Title

First Name

SAMUEL

Middle

GUY

Last Name

RUSSELL

Business Name

SAMUEL GUY RUSSELL MD

Original Issue Date

06/24/2017

Effective Date

06/24/2017

Expiration Date

06/23/2020

City

LINCOLNSHIRE

State

Zip

60069

County

LAKE

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

04/19/2017