KEISHA MARTINEZ POWELL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063014

License Status

CANCELLED

Business

Title

First Name

KEISHA

Last Name

MARTINEZ POWELL

Business Name

KEISHA MARTINEZ POWELL MD

Original Issue Date

06/27/2015

Effective Date

06/27/2015

Expiration Date

06/26/2016

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Child and Adolescent Psychiatry

Ever Disciplined

LastModifiedDate

06/03/2015