KELLY A ROTH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075293

License Status

CANCELLED

Business

Title

First Name

KELLY

Middle

Last Name

ROTH

Business Name

KELLY A ROTH MD

Original Issue Date

07/10/2019

Effective Date

07/10/2019

Expiration Date

07/09/2022

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

07/10/2019