KATHLEEN A LAKE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

KATHLEEN A

Last Name

LAKE

Business Name

KATHLEEN A LAKE

Original Issue Date

06/04/1993

Effective Date

07/27/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014

Case Number

2012000463

Action

Revocation

Discipline Start Date

06/11/2013

Discipline Reason

after being convicted of a felony and surrendered her Drug Enforcement Administration Registration for cause.