FREDERICK M TIESENGA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

First Name

FREDERICK M

Last Name

TIESENGA

Suffix

Business Name

FREDERICK M TIESENGA MD

Original Issue Date

09/11/1995

Effective Date

05/09/2023

Expiration Date

07/31/2026

City

ELMWOOD PARK

State

Zip

60707

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2023