LAUREL KIETZMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

Title

First Name

LAUREL

Last Name

KIETZMAN

Business Name

LAUREL KIETZMAN MD

Original Issue Date

08/25/2010

Effective Date

08/25/2010

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60644

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020