KENNETH WAYNE DOUGLAS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125038852

License Status

CANCELLED

Business

First Name

KENNETH

Middle

WAYNE

Last Name

DOUGLAS

Suffix

Business Name

KENNETH WAYNE DOUGLAS MD

Original Issue Date

09/02/1998

Effective Date

09/02/1998

Expiration Date

08/03/2001

City

MAYWOOD

State

Zip

60153

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006