KIRK SHANE RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

Title

First Name

KIRK

Middle

SHANE

Last Name

RUSSELL

Business Name

KIRK SHANE RUSSELL MD

Original Issue Date

05/01/2013

Effective Date

05/01/2013

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014