BRENDA S WALLER MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036075610

License Status

INACTIVE

Business

First Name

BRENDA S

Last Name

WALLER

Suffix

Business Name

BRENDA S WALLER MD

Original Issue Date

09/23/1987

Effective Date

09/23/1987

Expiration Date

07/31/1990

City

OAK PARK

State

Zip

60304

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006