SAMUEL WALLACE BRADY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085008789

License Status

NOT RENEWED

Business

First Name

SAMUEL

Middle

WALLACE

Last Name

BRADY

Business Name

SAMUEL WALLACE BRADY

Original Issue Date

12/29/2021

Effective Date

12/29/2021

Expiration Date

03/01/2024

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

02/05/2025