BRADFORD C WISNOUSKY DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035903

License Status

EXPIRED

Business

First Name

BRADFORD

Middle

Last Name

WISNOUSKY

Suffix

Business Name

BRADFORD C WISNOUSKY DO

Original Issue Date

05/09/1997

Effective Date

05/09/1997

Expiration Date

06/30/2000

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006