SUSAN KATHLEEN DIETZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

KATHLEEN

Last Name

DIETZ

Suffix

Business Name

SUSAN KATHLEEN DIETZ MD

Original Issue Date

02/26/1998

Effective Date

02/26/1998

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006