SHANE TODD RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

SHANE

Middle

TODD

Last Name

RUSSELL

Suffix

Business Name

SHANE TODD RUSSELL MD

Original Issue Date

06/29/2005

Effective Date

06/29/2005

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008