DIANE W FONDRIEST MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

ACTIVE

Business

First Name

DIANE W

Last Name

FONDRIEST

Suffix

Business Name

DIANE W FONDRIEST MD

Original Issue Date

03/11/1983

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023