MARK JAMES KELLEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

MARK

Middle

JAMES

Last Name

KELLEN

Suffix

Business Name

MARK JAMES KELLEN MD

Original Issue Date

05/08/1998

Effective Date

05/08/1998

Expiration Date

07/31/1999

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020