JONATHAN W WALLACE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108563

License Status

ACTIVE

Business

First Name

JONATHAN

Middle

Last Name

WALLACE

Business Name

JONATHAN W WALLACE

Original Issue Date

02/10/2003

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

HOFFMAN ESTATES

State

Zip

60192

County

COOK

Ever Disciplined

LastModifiedDate

04/07/2023