DEREK JOSEPH KELLY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036063365

License Status

ACTIVE

Business

First Name

DEREK JOSEPH

Last Name

KELLY

Suffix

Business Name

DEREK JOSEPH KELLY MD

Original Issue Date

10/09/1981

Effective Date

05/06/2023

Expiration Date

07/31/2026

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

05/06/2023

Case Number

2019009283

Action

Suspension

Discipline Start Date

12/06/2019

Discipline End Date

12/13/2019

Discipline Reason

Failure to file and/or pay Illinois state income taxes. Notice of tax deficiency release received from Department of Revenue on 12/16/2019.