WILLIAM B CIVILETTA-KALICH Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

INOPERATIVE

Business

First Name

WILLIAM

Middle

Last Name

CIVILETTA-KALICH

Business Name

WILLIAM B CIVILETTA-KALICH

Original Issue Date

06/23/2010

Effective Date

01/25/2022

Expiration Date

03/01/2024

City

ZION

State

Zip

60099

County

LAKE

Ever Disciplined

LastModifiedDate

12/06/2023