WALLACE CHAMON A SIQUEIRA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING PHYSICIAN PROFESSOR

License Number

113000060

License Status

EXPIRED

Business

Title

First Name

WALLACE

Middle

CHAMON A

Last Name

SIQUEIRA

Business Name

WALLACE CHAMON A SIQUEIRA MD

Original Issue Date

09/22/2011

Effective Date

09/22/2011

Expiration Date

08/21/2012

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

10/11/2012