RICHARD BANJASTI CHUSAK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

First Name

RICHARD BANJASTI

Last Name

CHUSAK

Suffix

Business Name

RICHARD BANJASTI CHUSAK MD

Original Issue Date

04/17/2003

Effective Date

04/17/2003

Expiration Date

07/31/2008

City

RED BUD

State

Zip

62278

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008