SUSAN R RUSSELL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

ACTIVE

Business

First Name

SUSAN

Middle

Last Name

RUSSELL

Business Name

SUSAN R RUSSELL

Original Issue Date

03/07/2007

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2023