RUSSELL LOUIS MAIESE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151675

License Status

NOT RENEWED

Business

First Name

RUSSELL

Middle

LOUIS

Last Name

MAIESE

Business Name

RUSSELL LOUIS MAIESE

Original Issue Date

01/29/2020

Effective Date

07/13/2020

Expiration Date

07/31/2023

City

PINE BROOK

State

Zip

07058

Ever Disciplined

LastModifiedDate

11/30/2023