MADISON JEAN KEIKO MIYAKE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****28

License Status

ACTIVE

Business

First Name

MADISON

Middle

JEAN KEIKO

Last Name

MIYAKE

Business Name

MADISON JEAN KEIKO MIYAKE

Original Issue Date

10/23/2023

Effective Date

02/24/2026

Expiration Date

03/01/2028

City

SKOKIE

State

Zip

60076

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026