SAMUEL FREDERICK BRUNK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

Title

First Name

SAMUEL

Middle

FREDERICK

Last Name

BRUNK

Business Name

SAMUEL FREDERICK BRUNK MD

Original Issue Date

03/25/2009

Effective Date

03/25/2009

Expiration Date

07/31/2011

City

ZION

State

Zip

60099

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011