CARLA DENISE SAMUEL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

Title

First Name

CARLA

Middle

DENISE

Last Name

SAMUEL

Business Name

CARLA DENISE SAMUEL MD

Original Issue Date

09/04/2009

Effective Date

05/05/2023

Expiration Date

07/31/2026

City

MAHOMET

State

Zip

61853

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/05/2023