ERSTA PUTRA FERRYANTO DPM Podiatrist License verification

Business Entity

ACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****60

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

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/19/2024