LEE MICHAEL TISA DPM - Podiatrist License in Wisconsin | # 016003410

LEE MICHAEL TISA DPM

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016003410

License Status

NOT RENEWED

Business

N

First Name

LEE

Middle

MICHAEL

Last Name

TISA

Suffix

DPM

Business Name

LEE MICHAEL TISA DPM

Original Issue Date

06/17/1982

Effective Date

11/26/2014

Expiration Date

01/31/2017

State

WI

Ever Disciplined

Y

LastModifiedDate

03/27/2017

Case Number

2003008140

Action

Probation

Discipline Start Date

05/20/2008

Discipline End Date

05/19/2009

Discipline Reason

Unprofessional conduct for addiction to an illegal controlled substance.