KELLY A ROTH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036159787

License Status

ACTIVE

Business

Title

First Name

KELLY

Middle

Last Name

ROTH

Business Name

KELLY A ROTH MD

Original Issue Date

03/15/2022

Effective Date

05/15/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

Ever Disciplined

LastModifiedDate

05/15/2023