BENJAMIN P KIETZMAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

CANCELLED

Business

First Name

BENJAMIN P

Last Name

KIETZMAN

Suffix

Business Name

BENJAMIN P KIETZMAN MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2005

City

WHEATON

State

Zip

60187

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006