WALDEMAR MYSIAK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035422

License Status

EXPIRED

Business

First Name

WALDEMAR

Last Name

MYSIAK

Business Name

WALDEMAR MYSIAK

Original Issue Date

07/18/1996

Effective Date

07/18/1996

Expiration Date

07/17/1999

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006