ALEC SAMUEL SMALL DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078868

License Status

CANCELLED

Business

Title

First Name

ALEC

Middle

SAMUEL

Last Name

SMALL

Business Name

ALEC SAMUEL SMALL DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/15/2021