MARK E WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013238

License Status

EXPIRED

Business

First Name

MARK E

Last Name

WALLACE

Suffix

Business Name

MARK E WALLACE MD

Original Issue Date

06/30/1981

Effective Date

06/30/1981

Expiration Date

07/01/1983

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006