ELISE C PIEBENGA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041628

License Status

EXPIRED

Business

First Name

ELISE

Middle

Last Name

PIEBENGA

Business Name

ELISE C PIEBENGA

Original Issue Date

06/19/2000

Effective Date

06/19/2000

Expiration Date

06/18/2003

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006