KELLEY E BANAGAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

First Name

KELLEY

Middle

Last Name

BANAGAN

Suffix

Business Name

KELLEY E BANAGAN MD

Original Issue Date

04/07/2010

Effective Date

04/07/2010

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011