DENISE DEBRA DEWALD MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055084

License Status

CANCELLED

Business

Title

First Name

DENISE

Middle

DEBRA

Last Name

DEWALD

Business Name

DENISE DEBRA DEWALD MD

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/20/2011