DIANE M W BONTKE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036858

License Status

EXPIRED

Business

First Name

DIANE

Middle

M W

Last Name

BONTKE

Suffix

Business Name

DIANE M W BONTKE MD

Original Issue Date

06/19/1997

Effective Date

06/19/1997

Expiration Date

06/30/2001

City

PEORIA

State

Zip

61637

County

PEORIA

Ever Disciplined

LastModifiedDate

09/22/2006