DENISE DESIREE WALLIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048613

License Status

CANCELLED

Business

First Name

DENISE

Middle

DESIREE

Last Name

WALLIS

Suffix

Business Name

DENISE DESIREE WALLIS MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006