TEACKLE WALLIS MARTIN JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048316

License Status

NOT RENEWED

Business

First Name

TEACKLE WALLIS

Last Name

MARTIN JR

Suffix

Business Name

TEACKLE WALLIS MARTIN JR MD

Original Issue Date

09/19/1973

Effective Date

09/19/1973

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006