DIANE W FONDRIEST MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125012415

License Status

EXPIRED

Business

First Name

DIANE W

Last Name

FONDRIEST

Suffix

Business Name

DIANE W FONDRIEST MD

Original Issue Date

06/17/1981

Effective Date

06/17/1981

Expiration Date

06/22/1983

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006