SHIRLY SUSAN SAMUEL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

ACTIVE

Business

Title

First Name

SHIRLY

Middle

SUSAN

Last Name

SAMUEL

Business Name

SHIRLY SUSAN SAMUEL MD

Original Issue Date

08/11/2023

Effective Date

08/11/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60607

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/18/2023