JACOB JOHN FONDRIEST MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001397

License Status

EXPIRED

Business

Title

First Name

JACOB

Middle

JOHN

Last Name

FONDRIEST

Business Name

JACOB JOHN FONDRIEST MD

Original Issue Date

06/01/2021

Effective Date

06/01/2021

Expiration Date

06/30/2021

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

10/11/2022