KELLY MARIE LIESSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

NOT RENEWED

Business

Title

First Name

KELLY

Middle

MARIE

Last Name

LIESSE

Business Name

KELLY MARIE LIESSE MD

Original Issue Date

03/12/2020

Effective Date

07/10/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023