STACIE J BOSNYAK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

STACIE J

Last Name

BOSNYAK

Suffix

Business Name

STACIE J BOSNYAK MD

Original Issue Date

06/22/1990

Effective Date

06/22/1990

Expiration Date

07/31/1993

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006