RUSSELL M MILLER MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036068129

License Status

INACTIVE

Business

First Name

RUSSELL M

Last Name

MILLER

Suffix

Business Name

RUSSELL M MILLER MD

Original Issue Date

12/30/1983

Effective Date

09/30/2020

Expiration Date

07/31/2023

City

SOUTH BEND

State

Zip

46628

County

COOK

Ever Disciplined

LastModifiedDate

09/30/2020