TODD M JEZISEK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001552

License Status

NOT RENEWED

Business

First Name

TODD

Middle

Last Name

JEZISEK

Business Name

TODD M JEZISEK

Original Issue Date

01/30/2001

Effective Date

02/06/2012

Expiration Date

03/01/2014

City

BERWYN

State

Zip

60402

County

COOK

Ever Disciplined

LastModifiedDate

04/08/2014