GREG RUSSELL LICAMELI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

First Name

GREG RUSSELL

Last Name

LICAMELI

Suffix

Business Name

GREG RUSSELL LICAMELI MD

Original Issue Date

04/28/1997

Effective Date

04/28/1997

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/09/2006