WALDEMAR MYSIAK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

WALDEMAR

Last Name

MYSIAK

Business Name

WALDEMAR MYSIAK

Original Issue Date

04/08/1999

Effective Date

09/14/2020

Expiration Date

07/31/2023

City

GURNEE

State

Zip

60031

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023