FREDERICK M TIESENGA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026162

License Status

EXPIRED

Business

First Name

FREDERICK M

Last Name

TIESENGA

Suffix

Business Name

FREDERICK M TIESENGA MD

Original Issue Date

04/17/1991

Effective Date

04/17/1991

Expiration Date

06/23/1994

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006