BENJAMIN P KIETZMAN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036042271

License Status

INACTIVE

Business

First Name

BENJAMIN P

Last Name

KIETZMAN

Suffix

Business Name

BENJAMIN P KIETZMAN MD

Original Issue Date

12/20/1968

Effective Date

12/20/1968

Expiration Date

07/31/2005

City

WHEATON

State

Zip

60187

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006