KELLEY K STALEY Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046748

License Status

EXPIRED

Business

First Name

KELLEY

Middle

Last Name

STALEY

Business Name

KELLEY K STALEY

Original Issue Date

06/24/2003

Effective Date

06/24/2003

Expiration Date

06/23/2006

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006