KIMBERLY LYNN RUSSO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

KIMBERLY

Middle

LYNN

Last Name

RUSSO

Suffix

Business Name

KIMBERLY LYNN RUSSO MD

Original Issue Date

05/25/2005

Effective Date

06/27/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011