KIRA NICOLE LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

Title

First Name

KIRA

Middle

NICOLE

Last Name

LONG

Business Name

KIRA NICOLE LONG MD

Original Issue Date

11/12/2015

Effective Date

04/27/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021