STASIA DIANA ROUSE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

ACTIVE

Business

Title

First Name

STASIA

Middle

DIANA

Last Name

ROUSE

Business Name

STASIA DIANA ROUSE MD

Original Issue Date

05/13/2019

Effective Date

07/26/2023

Expiration Date

07/31/2026

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/26/2023