KIM KEITH WIESE - Physician Assistant License in Illinois | # 085006503

KIM KEITH WIESE

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006503

License Status

ACTIVE

Business

N

First Name

KIM

Middle

KEITH

Last Name

WIESE

Business Name

KIM KEITH WIESE

Original Issue Date

02/08/2018

Effective Date

12/05/2025

Expiration Date

03/01/2028

State

IL

Ever Disciplined

N

LastModifiedDate

12/05/2025