LAUREL KIETZMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

Title

First Name

LAUREL

Last Name

KIETZMAN

Business Name

LAUREL KIETZMAN MD

Original Issue Date

08/29/2007

Effective Date

06/26/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60623

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020