RUSTAN J WIERSMA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

CANCELLED

Business

First Name

RUSTAN J

Last Name

WIERSMA

Suffix

Business Name

RUSTAN J WIERSMA MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

LAGRANGE PARK

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006