DERRICK DANIEL THIEL DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046390

License Status

EXPIRED

Business

First Name

DERRICK

Middle

DANIEL

Last Name

THIEL

Suffix

Business Name

DERRICK DANIEL THIEL DO

Original Issue Date

06/19/2003

Effective Date

06/19/2003

Expiration Date

06/18/2004

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Rotating Internship

Ever Disciplined

LastModifiedDate

09/22/2006