KELLY S MACVITTIE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001525

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

MACVITTIE

Business Name

KELLY S MACVITTIE

Original Issue Date

12/12/2000

Effective Date

12/12/2000

Expiration Date

03/01/2004

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006