CRYSTAL LEA KITTISOPIKUL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****45

License Status

NOT RENEWED

Business

First Name

CRYSTAL

Middle

LEA

Last Name

KITTISOPIKUL

Business Name

CRYSTAL LEA KITTISOPIKUL

Original Issue Date

04/10/2018

Effective Date

04/10/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60610

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020