CHAD M KELLER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****96

License Status

INOPERATIVE

Business

First Name

CHAD M

Last Name

KELLER

Business Name

CHAD M KELLER

Original Issue Date

04/07/2005

Effective Date

03/05/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

12/18/2019