KELLY MARIE LOGAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062190

License Status

CANCELLED

Business

Title

First Name

KELLY

Middle

MARIE

Last Name

LOGAN

Business Name

KELLY MARIE LOGAN MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014