DIEGO PIVIDAL FERNANDEZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125086856

License Status

ACTIVE

Business

Title

First Name

DIEGO

Last Name

PIVIDAL FERNANDEZ

Business Name

DIEGO PIVIDAL FERNANDEZ MD

Original Issue Date

07/01/2025

Effective Date

07/01/2025

Expiration Date

06/30/2028

City

CHICAGO

State

Zip

60657

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/07/2025