THEODORE THOMAS DEITZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078500

License Status

CANCELLED

Business

Title

First Name

THEODORE

Middle

THOMAS

Last Name

DEITZ

Business Name

THEODORE THOMAS DEITZ MD

Original Issue Date

06/22/2021

Effective Date

06/22/2021

Expiration Date

06/21/2024

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/21/2021