SUSAN KATHLEEN DIETZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035032

License Status

EXPIRED

Business

First Name

SUSAN

Middle

KATHLEEN

Last Name

DIETZ

Suffix

Business Name

SUSAN KATHLEEN DIETZ MD

Original Issue Date

06/12/1996

Effective Date

06/12/1996

Expiration Date

06/30/1999

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006