STEPHEN THEODORE LIETZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

CANCELLED

Business

First Name

STEPHEN THEODORE

Last Name

LIETZ

Suffix

Business Name

STEPHEN THEODORE LIETZ MD

Original Issue Date

01/19/1982

Effective Date

01/19/1982

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006