ETHAN JAMES KSIAZEK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****60

License Status

ACTIVE

Business

First Name

ETHAN

Middle

JAMES

Last Name

KSIAZEK

Business Name

ETHAN JAMES KSIAZEK

Original Issue Date

04/04/2024

Effective Date

04/04/2024

Expiration Date

03/01/2026

City

CHICAGO

State

Zip

60611

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025