ERSTA PUTRA FERRYANTO DPM Podiatrist License verification

Business Entity

ACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016006049

License Status

ACTIVE

Business

Title

DPM

First Name

ERSTA

Middle

PUTRA

Last Name

FERRYANTO

Business Name

ERSTA PUTRA FERRYANTO DPM

Original Issue Date

04/03/2024

Effective Date

12/19/2024

Expiration Date

01/31/2027

City

CHICAGO

State

Zip

60625

Ever Disciplined

LastModifiedDate

12/19/2024