PHILIP A WALLER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125022613

License Status

EXPIRED

Business

First Name

PHILIP A

Last Name

WALLER

Suffix

Business Name

PHILIP A WALLER MD

Original Issue Date

06/03/1988

Effective Date

06/03/1988

Expiration Date

07/01/1991

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006