KEITH LOUIS WRAGE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

CANCELLED

Business

First Name

KEITH LOUIS

Last Name

WRAGE

Suffix

Business Name

KEITH LOUIS WRAGE MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II IV V

Ever Disciplined

LastModifiedDate

09/26/2006