KEITH MICHAEL D'SOUZA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

MICHAEL

Last Name

D'SOUZA

Suffix

Business Name

KEITH MICHAEL D'SOUZA MD

Original Issue Date

03/10/2008

Effective Date

04/25/2011

Expiration Date

07/31/2014

City

DANVILLE

State

Zip

61832

County

VERMILION

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014