KELSEY LASAGE MAZUR Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006470

License Status

NOT RENEWED

Business

First Name

KELSEY

Middle

LASAGE

Last Name

MAZUR

Business Name

KELSEY LASAGE MAZUR

Original Issue Date

12/20/2017

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022