STEPHANIE DIETZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148661

License Status

NOT RENEWED

Business

Title

First Name

STEPHANIE

Last Name

DIETZ

Business Name

STEPHANIE DIETZ MD

Original Issue Date

03/20/2019

Effective Date

03/20/2019

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021