DEIDRE ANNE DIETZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036125780

License Status

NOT RENEWED

Business

First Name

DEIDRE

Middle

ANNE

Last Name

DIETZ

Suffix

Business Name

DEIDRE ANNE DIETZ MD

Original Issue Date

05/17/2010

Effective Date

05/02/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014