DENNIS R SAMUELSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

NOT RENEWED

Business

First Name

DENNIS R

Last Name

SAMUELSON

Suffix

Business Name

DENNIS R SAMUELSON MD

Original Issue Date

01/01/1997

Effective Date

07/01/2014

Expiration Date

07/31/2017

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017