KIRT LEE EDLY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****85

License Status

NOT RENEWED

Business

First Name

KIRT

Middle

LEE

Last Name

EDLY

Business Name

KIRT LEE EDLY

Original Issue Date

08/26/2008

Effective Date

03/01/2010

Expiration Date

03/01/2012

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012