KEITH R FISH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

FISH

Suffix

Business Name

KEITH R FISH MD

Original Issue Date

02/22/2008

Effective Date

05/17/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021