KELLEY H ROUSE 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

KELLEY

Middle

Last Name

ROUSE

Business Name

KELLEY H ROUSE

Original Issue Date

06/08/2004

Effective Date

06/08/2004

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60622

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008