SUSAN YOUNG BOLOTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****30

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

YOUNG

Last Name

BOLOTIN

Business Name

SUSAN YOUNG BOLOTIN

Original Issue Date

07/22/2015

Effective Date

12/27/2019

Expiration Date

03/01/2022

City

PALATINE

State

Zip

60067

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022