MARIO G MASSULLO DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

ACTIVE

Business

First Name

MARIO G

Last Name

MASSULLO

Suffix

Business Name

MARIO G MASSULLO DO

Original Issue Date

07/15/1991

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023