MICHAEL RUSSO DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073843

License Status

CANCELLED

Business

Title

First Name

MICHAEL

Last Name

RUSSO

Business Name

MICHAEL RUSSO DO

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

CHICAGO

State

Zip

60618

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/09/2019