KEITH TRENT WHITE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045788

License Status

CANCELLED

Business

First Name

KEITH

Middle

TRENT

Last Name

WHITE

Suffix

Business Name

KEITH TRENT WHITE MD

Original Issue Date

04/30/2003

Effective Date

04/30/2003

Expiration Date

06/30/2004

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006