MARY ELIZABETH COPELAND KOZAK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077966

License Status

CANCELLED

Business

Title

First Name

MARY

Middle

ELIZABETH

Last Name

COPELAND KOZAK

Business Name

MARY ELIZABETH COPELAND KOZAK DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

PEORIA

State

Zip

61602

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/10/2021