KEITH LOUIS WRAGE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036041359

License Status

INACTIVE

Business

First Name

KEITH LOUIS

Last Name

WRAGE

Suffix

Business Name

KEITH LOUIS WRAGE MD

Original Issue Date

08/07/1967

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/20/2006