ROY HERMAN LIDTKE Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****26

License Status

NOT RENEWED

Business

First Name

ROY

Middle

HERMAN

Last Name

LIDTKE

Suffix

DPM DPM

Business Name

ROY HERMAN LIDTKE

Original Issue Date

08/05/2019

Effective Date

08/05/2019

Expiration Date

01/31/2021

City

PRINCETON

State

Zip

61356

County

BUREAU

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2021