ZIEMOWIT T MAZUR Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

NOT RENEWED

Business

First Name

ZIEMOWIT

Middle

Last Name

MAZUR

Business Name

ZIEMOWIT T MAZUR

Original Issue Date

09/09/2010

Effective Date

03/15/2018

Expiration Date

03/01/2020

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Ever Disciplined

LastModifiedDate

11/24/2020