MARK E WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036064532

License Status

NOT RENEWED

Business

First Name

MARK E

Last Name

WALLACE

Suffix

Business Name

MARK E WALLACE MD

Original Issue Date

06/18/1982

Effective Date

06/18/1982

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006