MICHAEL RANDALL KELLER Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

NOT RENEWED

Business

First Name

MICHAEL RANDALL

Last Name

KELLER

Business Name

MICHAEL RANDALL KELLER

Original Issue Date

11/07/1996

Effective Date

11/07/1996

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60631

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006