KEITH MICHAEL LERTSBURAPA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051479

License Status

CANCELLED

Business

First Name

KEITH

Middle

MICHAEL

Last Name

LERTSBURAPA

Suffix

Business Name

KEITH MICHAEL LERTSBURAPA MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2011

City

HINSDALE

State

Zip

60521

Specialty/Qualifier

Otolaryngology

Ever Disciplined

LastModifiedDate

01/18/2011