ANTON N DIETZEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069633

License Status

CANCELLED

Business

Title

First Name

ANTON

Middle

Last Name

DIETZEN

Business Name

ANTON N DIETZEN MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2019

City

WHEATON

State

Zip

60187

County

COOK

Specialty/Qualifier

Physical Medicine and Rehabilitation

Ever Disciplined

LastModifiedDate

06/12/2017