KIM C NUSSBAUM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

First Name

KIM

Middle

Last Name

NUSSBAUM

Business Name

KIM C NUSSBAUM

Original Issue Date

05/19/2005

Effective Date

05/19/2005

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011