SUSAN MARIE KSIAZEK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

MARIE

Last Name

KSIAZEK

Suffix

Business Name

SUSAN MARIE KSIAZEK MD

Original Issue Date

05/06/2002

Effective Date

06/05/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021