SHIRLY SUSAN SAMUEL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076605

License Status

CANCELLED

Business

Title

First Name

SHIRLY

Middle

SUSAN

Last Name

SAMUEL

Business Name

SHIRLY SUSAN SAMUEL MD

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

06/30/2023

City

OAK PARK

State

Zip

60302

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/16/2020