KATHLEEN MARIE WIESE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045300

License Status

EXPIRED

Business

First Name

KATHLEEN

Middle

MARIE

Last Name

WIESE

Suffix

Business Name

KATHLEEN MARIE WIESE DO

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

07/06/2006

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

09/22/2006