BREANN KELLEY SMITH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048166

License Status

CANCELLED

Business

First Name

BREANN

Middle

KELLEY

Last Name

SMITH

Suffix

Business Name

BREANN KELLEY SMITH MD

Original Issue Date

06/24/2004

Effective Date

06/24/2004

Expiration Date

06/23/2007

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006