TATEK KETEMA TAKELE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050292

License Status

CANCELLED

Business

Title

First Name

TATEK

Middle

KETEMA

Last Name

TAKELE

Business Name

TATEK KETEMA TAKELE MD

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/23/2008

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006