ANDRZEJ JAN WASIAK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

First Name

ANDRZEJ

Middle

JAN

Last Name

WASIAK

Suffix

Business Name

ANDRZEJ JAN WASIAK MD

Original Issue Date

10/04/1999

Effective Date

04/14/2011

Expiration Date

07/31/2014

City

COLUMBIA

State

Zip

62236

County

MONROE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014