SAMUEL SELASIE MORTOTI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

ACTIVE

Business

Title

First Name

SAMUEL SELASIE

Last Name

MORTOTI

Business Name

SAMUEL SELASIE MORTOTI MD

Original Issue Date

08/24/2018

Effective Date

07/21/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/21/2023