KEITH DAVID ROULEAU Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

DAVID

Last Name

ROULEAU

Business Name

KEITH DAVID ROULEAU

Original Issue Date

12/20/2011

Effective Date

12/20/2011

Expiration Date

03/01/2014

City

BARTLETT

State

Zip

60103

County

COOK

Ever Disciplined

LastModifiedDate

03/04/2015