WARREN H WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036055938

License Status

NOT RENEWED

Business

First Name

WARREN

Middle

Last Name

WALLACE

Suffix

Business Name

WARREN H WALLACE MD

Original Issue Date

12/16/1977

Effective Date

07/24/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017