KRISTIN KEGLOVITZ BAKER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****46

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

KEGLOVITZ

Last Name

BAKER

Business Name

KRISTIN KEGLOVITZ BAKER

Original Issue Date

07/17/2006

Effective Date

01/22/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60640

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022