SONG KEITH PIYAKA MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036047051

License Status

INACTIVE

Business

First Name

SONG KEITH

Last Name

PIYAKA

Suffix

Business Name

SONG KEITH PIYAKA MD

Original Issue Date

02/07/1973

Effective Date

04/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

04/05/2020