ELISE C PIEBENGA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108092

License Status

NOT RENEWED

Business

First Name

ELISE

Middle

Last Name

PIEBENGA

Business Name

ELISE C PIEBENGA

Original Issue Date

10/29/2002

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008