KELLY MARIE POLETIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****04

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

MARIE

Last Name

POLETIS

Business Name

KELLY MARIE POLETIS

Original Issue Date

10/01/2012

Effective Date

02/05/2016

Expiration Date

03/01/2018

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2018