TODD M JEZISEK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****08

License Status

NOT RENEWED

Business

First Name

TODD

Middle

Last Name

JEZISEK

Business Name

TODD M JEZISEK

Original Issue Date

03/15/2002

Effective Date

02/06/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

04/08/2014