BRADFORD C WISNOUSKY DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036100880

License Status

NOT RENEWED

Business

First Name

BRADFORD

Middle

Last Name

WISNOUSKY

Suffix

Business Name

BRADFORD C WISNOUSKY DO

Original Issue Date

08/04/1999

Effective Date

08/04/1999

Expiration Date

07/31/2002

City

EAST PEORIA

State

Zip

61611

County

TAZEWELL

Ever Disciplined

LastModifiedDate

10/09/2006