GEORGIA LEE KETCHUM-STREET MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

ACTIVE

Business

Title

First Name

GEORGIA

Middle

LEE

Last Name

KETCHUM-STREET

Business Name

GEORGIA LEE KETCHUM-STREET MD

Original Issue Date

09/10/2023

Effective Date

09/10/2023

Expiration Date

07/31/2026

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/10/2023