JAMES DOUGLAS DIETERICH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079167

License Status

CANCELLED

Business

Title

First Name

JAMES

Middle

DOUGLAS

Last Name

DIETERICH

Business Name

JAMES DOUGLAS DIETERICH MD

Original Issue Date

08/01/2022

Effective Date

08/01/2022

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60625

County

COOK

Specialty/Qualifier

Hand Surgery(Surgery)

Ever Disciplined

LastModifiedDate

12/02/2021