ELISE C PIEBENGA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

NOT RENEWED

Business

First Name

ELISE

Middle

Last Name

PIEBENGA

Business Name

ELISE C PIEBENGA

Original Issue Date

03/04/2003

Effective Date

03/04/2003

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008