ABDUREZAG A KDESH (Credential# 553912) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2019. The license expiration date date is July 31, 2020. The license status is ACTIVE.
ABDUREZAG A KDESH is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.036320. The credential type is physician/surgeon. The effective date is August 1, 2019. The expiration date is July 31, 2020. The business address is 2208 Katy Lane, Columbia, MO 65203. The current status is active.
| Licensee Name | ABDUREZAG A KDESH |
| Credential ID | 553912 |
| Credential Number | 1.036320 |
| Credential Type | Physician/Surgeon |
| Business Address |
2208 Katy Lane Columbia MO 65203 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1997-08-22 |
| Effective Date | 2019-08-01 |
| Expiration Date | 2020-07-31 |
| Refresh Date | 2019-07-29 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 186365 | CSP.0026075 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-03-01 - 2007-02-28 | INACTIVE |
| Street Address | 2208 Katy lane |
| City | Columbia |
| State | MO |
| Zip Code | 65203 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Timothy D Crockett | 1000 W Nifong Blvd., Bldg. 1, Columbia, MO 65203 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Zhiqiang Hu Ph.d | 3003 Funderburg Mill Dr, Columbia, MO 65203 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Monika Michaela Prost | 3305 Crawford Street, Columbia, MO 65203 | Physician/surgeon | 2019-11-04 ~ 2020-07-31 |
| Beata J Sowa | 1002 Sycamore Ln, Columbia, MO 65203 | Registered Nurse | 2019-11-01 ~ 2020-10-31 |
| Elizabeth Michelle D'agostino | 2711 Summit Rd Apt A, Columbia, MO 65203 | Registered Nurse - Temporary | 2017-08-21 ~ 2017-12-18 |
| James R Berchek | 211 Edgewood Ave, Columbia, MO 65203 | Pharmacist | 2012-02-01 ~ 2014-01-31 |
| Kraig Lee Spence | 2005 W. Broadway, Columbia, MO 65203 | Professional Engineer | 2013-02-01 ~ 2014-01-31 |
| Janet Sullivan | 213 Longfellow Lane, Columbia, MO 65203 | Physician/surgeon | 2009-01-02 ~ 2009-11-30 |
| Hye Ryun H Kim | 1021 Yale, Columbia, MO 65203 | Occupational Therapist | ~ 1999-07-31 |
| Ila M Wilson | 405 Manor Dr, Columbia, MO 65203 | Registered Nurse | 2004-06-08 ~ 2005-07-31 |
| Find all Licenses in zip 65203 | |||
| City | Columbia |
| Zip Code | 65203 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Columbia |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Sajot S Grewal Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2004-01-30 ~ 2005-03-31 |
| Barbara A Brandes Md | Danbury Office of Physician Services, Danbury, CT 06810 | Physician/surgeon | 2004-07-08 ~ 2005-07-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).