KELLY DIANE FORD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093033

License Status

NOT RENEWED

Business

First Name

KELLY DIANE

Last Name

FORD

Suffix

Business Name

KELLY DIANE FORD MD

Original Issue Date

06/05/1996

Effective Date

06/05/1996

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006