HEIDI C MEMMEL MITIDIERO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

ACTIVE

Business

Title

First Name

HEIDI

Middle

Last Name

MEMMEL MITIDIERO

Business Name

HEIDI C MEMMEL MITIDIERO MD

Original Issue Date

07/28/2004

Effective Date

07/06/2023

Expiration Date

07/31/2026

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/06/2023