ERSTA PUTRA FERRYANTO DPM Podiatrist License verification

Business Entity

EXPIRED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135001138

License Status

EXPIRED

Business

Title

DPM

First Name

ERSTA

Middle

PUTRA

Last Name

FERRYANTO

Business Name

ERSTA PUTRA FERRYANTO DPM

Original Issue Date

06/16/2021

Effective Date

06/25/2021

Expiration Date

06/24/2024

City

CHICAGO

State

Zip

60625

Ever Disciplined

LastModifiedDate

10/18/2024