LISA MARIE WIEDEL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125037343

License Status

CANCELLED

Business

First Name

LISA

Middle

MARIE

Last Name

WIEDEL

Suffix

Business Name

LISA MARIE WIEDEL MD

Original Issue Date

07/01/1998

Effective Date

07/01/1998

Expiration Date

06/30/2001

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006