KELLY SUSAN SKOUMAL Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

NOT RENEWED

Business

First Name

KELLY SUSAN

Last Name

SKOUMAL

Business Name

KELLY SUSAN SKOUMAL

Original Issue Date

10/03/1997

Effective Date

10/03/1997

Expiration Date

07/31/1999

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006