KEITH R WALLEY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

NOT RENEWED

Business

First Name

KEITH R

Last Name

WALLEY

Suffix

Business Name

KEITH R WALLEY MD

Original Issue Date

08/22/1985

Effective Date

08/22/1985

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006