AVIDA NUBIA BUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

Title

First Name

AVIDA

Middle

NUBIA

Last Name

BUSSELL

Business Name

AVIDA NUBIA BUSSELL MD

Original Issue Date

01/13/2012

Effective Date

05/30/2017

Expiration Date

09/30/2020

City

HAZEL CREST

State

Zip

60429

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021