MICHAEL RANDALL KELLER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125031635

License Status

EXPIRED

Business

First Name

MICHAEL RANDALL

Last Name

KELLER

Business Name

MICHAEL RANDALL KELLER

Original Issue Date

06/01/1994

Effective Date

06/01/1994

Expiration Date

06/26/1997

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006