RUSSELL MARK REISNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

NOT RENEWED

Business

Title

First Name

RUSSELL

Middle

MARK

Last Name

REISNER

Business Name

RUSSELL MARK REISNER MD

Original Issue Date

06/30/2009

Effective Date

06/30/2011

Expiration Date

07/31/2014

City

ZION

State

Zip

60099

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014