FREDERICK JAY KELLAWAY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

CANCELLED

Business

First Name

FREDERICK

Middle

JAY

Last Name

KELLAWAY

Suffix

Business Name

FREDERICK JAY KELLAWAY MD

Original Issue Date

06/10/2004

Effective Date

06/10/2004

Expiration Date

07/31/2005

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017