KATHLEEN A LAKE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125024927

License Status

EXPIRED

Business

First Name

KATHLEEN A

Last Name

LAKE

Business Name

KATHLEEN A LAKE

Original Issue Date

05/22/1990

Effective Date

05/22/1990

Expiration Date

06/30/1993

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006