BARBARA WIETIES MALM Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036068572

License Status

INACTIVE

Business

First Name

BARBARA WIETIES

Last Name

MALM

Business Name

BARBARA WIETIES MALM

Original Issue Date

04/25/1984

Effective Date

05/11/2011

Expiration Date

07/31/2014

City

FRANKFORT

State

Zip

60423

County

WILL

Ever Disciplined

LastModifiedDate

04/08/2014