SMITHA GRACE C SAMUEL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

NOT RENEWED

Business

Title

First Name

SMITHA GRACE

Middle

Last Name

SAMUEL

Business Name

SMITHA GRACE C SAMUEL MD

Original Issue Date

03/30/2010

Effective Date

03/30/2010

Expiration Date

07/31/2011

City

CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020