JACQUELINE R KELLY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

Title

First Name

JACQUELINE

Middle

Last Name

KELLY

Business Name

JACQUELINE R KELLY MD

Original Issue Date

01/21/2021

Effective Date

01/21/2021

Expiration Date

07/31/2023

City

ZION

State

Zip

60099

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023