KEITH R FISH MD (Credential# 555886) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2012. The license expiration date date is June 30, 2013. The license status is INACTIVE.
KEITH R FISH MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.038296. The credential type is physician/surgeon. The effective date is July 1, 2012. The expiration date is June 30, 2013. The business address is 1313 W Carmen Ave Apt 2f, Chicago, IL 60640-4813. The current status is inactive.
| Licensee Name | KEITH R FISH MD |
| Credential ID | 555886 |
| Credential Number | 1.038296 |
| Credential Type | Physician/Surgeon |
| Business Address |
1313 W Carmen Ave Apt 2f Chicago IL 60640-4813 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1999-12-03 |
| Effective Date | 2012-07-01 |
| Expiration Date | 2013-06-30 |
| Refresh Date | 2013-10-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 243324 | CSP.0030026 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-03-01 - 2009-02-28 | INACTIVE |
| Street Address | 1313 W CARMEN AVE APT 2F |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-4813 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carolyn Goldstein | 5251 N. Winthrop Ave., Chicago, IL 60640 | Registered Nurse | 2020-04-01 ~ 2021-04-30 |
| Stop Foodborne Illness | 4809 N Ravenswood Ave Ste 214, Chicago, IL 60640 | Public Charity | 2018-12-01 ~ 2019-07-31 |
| Macvad Usa Ltd. | 5530 N Broadway St., Chicago, IL 60640 | Importer of Bedding & Upholstered Furniture | 2018-03-16 ~ |
| Pm Lester D De La Cruz | 1415 W Poster Ave, Chicago, IL 60640 | Physical Therapist | ~ |
| Himansu S Pal · Viggo Bonnesen & Associates | 5320 N Sheridan Rd#1211, Chicago, IL 60640 | Professional Engineer | 1990-02-22 ~ 1991-01-31 |
| Jonathan D Ruiz | 1415 W. Foster Avenue, Chicago, IL 60640 | Physical Therapist | 2009-04-13 ~ 2010-04-30 |
| John Alanson Arnold IIi · Cornes & Drew | 4648 N Kenmore Ave, Chicago, IL 60640 | Architect | ~ |
| Mansour V Makhlouf | 1945 W Wilson Ave, Chicago, IL 60640 | Physician/surgeon | 1996-09-12 ~ 1997-06-30 |
| Erin R Shawn | 5419 N Ravenswood, Chicago, IL 60640 | Registered Nurse | 2006-04-19 ~ 2007-06-30 |
| Elizabeth A Soule' | 4745 N Malden #302, Chicago, IL 60640 | Optometrist | 1996-09-30 ~ 1997-09-30 |
| Find all Licenses in zip 60640 | |||
| City | CHICAGO |
| Zip Code | 60640 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + CHICAGO |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Daniel N Fish | 60 Old New Milford Rd Ste 3e, Brookfield, CT 06804-2414 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Mohammad Kamran Md | 2435 Fish Ave, Bronx, NY 10469 | Physician/surgeon | 2007-04-23 ~ 2008-03-31 |
| Todd W Mandell Md | 55 Fish Fry Street, Hartford, CT 06120 | Physician/surgeon | 2016-06-01 ~ 2017-05-31 |
| Keith C Boldon Md | Keith Boldon Md, Cheshire, CT 06410 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Bernard G Fish | 82 Coralyn Avenue, White Plains, NY 10605 | Physician/surgeon | 2017-02-01 ~ 2018-01-31 |
| Stephen W Wilz | 3425 Fish Hatchery Road, Allentown, PA 18103 | Physician/surgeon | 2002-06-17 ~ 2003-03-31 |
| Keith Edwards | 140 Hospital Dr, Bennington, VT 05201 | Physician/surgeon | 1992-07-23 ~ 1993-06-30 |
| Keith Gallagher | 11 Bishop St, New Haven, CT 06511-3931 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Keith Ray Hodge Md | 95 Dover Rd, W Hartford, CT 06119 | Physician/surgeon | 2001-03-12 ~ 2002-03-31 |
| Keith A Hernandez Md | 193 River Rd, Madison, CT 06443 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Please comment or provide details below to improve the information on KEITH R FISH MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).