LARRY A WICKLESS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036122645

License Status

NOT RENEWED

Business

First Name

LARRY

Middle

Last Name

WICKLESS

Business Name

LARRY A WICKLESS

Original Issue Date

02/19/2009

Effective Date

02/19/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60602

County

COOK

Ever Disciplined

LastModifiedDate

11/14/2011