KEITH FREDERICK MUCCINO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036112339

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

FREDERICK

Last Name

MUCCINO

Suffix

Business Name

KEITH FREDERICK MUCCINO MD

Original Issue Date

09/14/2004

Effective Date

07/20/2017

Expiration Date

09/30/2020

City

OAK PARK

State

Zip

60302

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021