TERESA M KLYSZEJKO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

CANCELLED

Business

First Name

TERESA M

Last Name

KLYSZEJKO

Business Name

TERESA M KLYSZEJKO

Original Issue Date

11/19/2002

Effective Date

11/19/2002

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006