KEITH G PORTER Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

KEITH G

Last Name

PORTER

Business Name

KEITH G PORTER

Original Issue Date

05/07/1997

Effective Date

05/07/1997

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006