DEPARTMENT OF INSURANCE

Name	Tubergen, Keith	DOIID	575938	NAIC NPN	983269

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	10/30/2019	4/30/2022
Inactive	Non Resident	Agent	Property	10/30/2019	4/30/2022
Inactive	Non Resident	Agent	Casualty	10/30/2019	4/30/2022

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	The Campbell Group 4808 Broadmoor Ave SeKentwood, MI 495125306
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(800) 938-7825