THOMAS JEFFREY DIETRICH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

JEFFREY

Last Name

DIETRICH

Suffix

Business Name

THOMAS JEFFREY DIETRICH MD

Original Issue Date

06/22/1999

Effective Date

06/22/1999

Expiration Date

07/31/2005

City

EVANSTON

State

Zip

60202

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006