RUSSELL F KELLY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

RUSSELL F

Last Name

KELLY

Suffix

Business Name

RUSSELL F KELLY MD

Original Issue Date

06/09/1995

Effective Date

05/02/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021