RENATA B PTAK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

NOT RENEWED

Business

First Name

RENATA

Middle

Last Name

PTAK

Business Name

RENATA B PTAK

Original Issue Date

03/31/2010

Effective Date

03/31/2010

Expiration Date

03/01/2012

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

04/16/2012