KEITH MICHAEL D'SOUZA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050233

License Status

CANCELLED

Business

First Name

KEITH

Middle

MICHAEL

Last Name

D'SOUZA

Suffix

Business Name

KEITH MICHAEL D'SOUZA MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

WHEATON

State

Zip

60187

County

DUPAGE

Ever Disciplined

LastModifiedDate

01/19/2011