MARY K RUSSELL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

ACTIVE

Business

Title

First Name

MARY

Middle

Last Name

RUSSELL

Business Name

MARY K RUSSELL MD

Original Issue Date

05/17/2019

Effective Date

07/01/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60622

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/01/2023