KIRT LEE EDLY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003072

License Status

NOT RENEWED

Business

First Name

KIRT

Middle

LEE

Last Name

EDLY

Business Name

KIRT LEE EDLY

Original Issue Date

09/27/2007

Effective Date

03/01/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60626

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012