HEIDI C MEMMEL MITIDIERO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039234

License Status

EXPIRED

Business

Title

First Name

HEIDI

Middle

Last Name

MEMMEL MITIDIERO

Business Name

HEIDI C MEMMEL MITIDIERO MD

Original Issue Date

06/28/1999

Effective Date

06/28/1999

Expiration Date

06/27/2003

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006