TIMOTHY MICHAEL KETTERHAGEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061976

License Status

CANCELLED

Business

Title

First Name

TIMOTHY

Middle

MICHAEL

Last Name

KETTERHAGEN

Business Name

TIMOTHY MICHAEL KETTERHAGEN MD

Original Issue Date

06/25/2012

Effective Date

06/25/2012

Expiration Date

06/24/2015

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014