ELYSA WIDJAJA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036161747

License Status

ACTIVE

Business

Title

First Name

ELYSA

Last Name

WIDJAJA

Business Name

ELYSA WIDJAJA MD

Original Issue Date

08/02/2022

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

04/06/2023