MARISSA JANE VERSALLE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

ACTIVE

Business

Title

First Name

MARISSA

Middle

JANE

Last Name

VERSALLE

Business Name

MARISSA JANE VERSALLE DO

Original Issue Date

07/26/2018

Effective Date

04/25/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60647

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/25/2023