LANCE T WALLACE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036085478

License Status

ACTIVE

Business

First Name

LANCE T

Last Name

WALLACE

Business Name

LANCE T WALLACE

Original Issue Date

10/14/1992

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

MATTESON

State

Zip

60443

County

COOK

Ever Disciplined

LastModifiedDate

08/21/2024