BENJAMIN JEROME TIETZ DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125084366

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

JEROME

Last Name

TIETZ

Business Name

BENJAMIN JEROME TIETZ DO

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2027

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

06/08/2024