DEIDRE ANNE DIETZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

DEIDRE

Middle

ANNE

Last Name

DIETZ

Suffix

Business Name

DEIDRE ANNE DIETZ MD

Original Issue Date

05/18/2010

Effective Date

05/02/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014