NICO J DIEDERICH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING PHYSICIAN PERMIT

License Number

106000025

License Status

EXPIRED

Business

First Name

NICO

Middle

Last Name

DIEDERICH

Business Name

NICO J DIEDERICH

Original Issue Date

12/20/1995

Effective Date

12/20/1995

Expiration Date

05/15/1996

City

CHICAGO

State

Zip

60617

County

COOK

Ever Disciplined

LastModifiedDate

09/23/2006