LARA MARIE WIZIECKI DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036856

License Status

EXPIRED

Business

First Name

LARA

Middle

MARIE

Last Name

WIZIECKI

Suffix

Business Name

LARA MARIE WIZIECKI DO

Original Issue Date

06/19/1997

Effective Date

06/19/1997

Expiration Date

06/22/2000

City

OLYMPIA FLDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006