KELLY A ROTH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

ACTIVE

Business

Title

First Name

KELLY

Middle

Last Name

ROTH

Business Name

KELLY A ROTH MD

Original Issue Date

09/11/2025

Effective Date

09/11/2025

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/11/2025