KELLY ANN LUCIANO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061583

License Status

CANCELLED

Business

Title

First Name

KELLY

Middle

ANN

Last Name

LUCIANO

Business Name

KELLY ANN LUCIANO MD

Original Issue Date

06/26/2012

Effective Date

06/26/2012

Expiration Date

06/25/2015

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014