JACOB ANTHONY KALLIATH DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

ACTIVE

Business

Title

First Name

JACOB

Middle

ANTHONY

Last Name

KALLIATH

Business Name

JACOB ANTHONY KALLIATH DO

Original Issue Date

07/21/2015

Effective Date

06/04/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/13/2024