KRISTIAN RUSSELL LARSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079623

License Status

CANCELLED

Business

Title

First Name

KRISTIAN

Middle

RUSSELL

Last Name

LARSON

Business Name

KRISTIAN RUSSELL LARSON MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

11/07/2024