KELLI M KELLER Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048412

License Status

CANCELLED

Business

First Name

KELLI

Middle

Last Name

KELLER

Business Name

KELLI M KELLER

Original Issue Date

06/28/2004

Effective Date

06/28/2004

Expiration Date

06/27/2007

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006