SAMUEL GUY RUSSELL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

ACTIVE

Business

Title

First Name

SAMUEL

Middle

GUY

Last Name

RUSSELL

Business Name

SAMUEL GUY RUSSELL MD

Original Issue Date

04/02/2020

Effective Date

05/27/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/27/2023