License holder summary

KEITH THOMAS HUSTAK is a Physician's Assistant - Physician Assistant Temporary licensed to practice in Michigan. The address on file for KEITH THOMAS HUSTAK is Detroit, MI 48226. This licensed professional license is not current. The license was granted 06/02/2004 and expired on 12/02/2005.

Michigan

Department of Licensing and Regulation

KEITH THOMAS HUSTAK
Physician's Assistant - Physician Assistant Temporary
License number
5601004306
Date granted
06/02/2004
Date expires
12/02/2005
Class
Physician's Assistant - Physician Assistant Temporary
Status
Voided
Address
Detroit, MI 48226
michiganlicensing.org
ID 25998925
LAST UPDATED 2024-04-19 21:06:48 UTC

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