HEATHER DIEPERINK OPTHOLT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

Title

First Name

HEATHER

Middle

DIEPERINK

Last Name

OPTHOLT

Business Name

HEATHER DIEPERINK OPTHOLT MD

Original Issue Date

06/02/2009

Effective Date

06/02/2009

Expiration Date

07/31/2011

City

WAUKEGAN

State

Zip

60085

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020