NICO J DIEDERICH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125021751

License Status

EXPIRED

Business

First Name

NICO

Middle

Last Name

DIEDERICH

Business Name

NICO J DIEDERICH

Original Issue Date

10/05/1987

Effective Date

10/05/1987

Expiration Date

12/31/1993

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

05/29/2007