JESSICA MARIE DIETHELM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048053

License Status

EXPIRED

Business

First Name

JESSICA

Middle

MARIE

Last Name

DIETHELM

Suffix

Business Name

JESSICA MARIE DIETHELM MD

Original Issue Date

06/24/2004

Effective Date

06/24/2004

Expiration Date

06/23/2007

City

CHICAGO

State

Zip

60612

Ever Disciplined

LastModifiedDate

07/03/2007