CHARITY ANNELIEN WIP MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139103

License Status

NOT RENEWED

Business

Title

First Name

CHARITY

Middle

ANNELIEN

Last Name

WIP

Business Name

CHARITY ANNELIEN WIP MD

Original Issue Date

09/17/2015

Effective Date

09/17/2015

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/01/2017