MICHELLE DIANNE WILLIS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056000

License Status

CANCELLED

Business

Title

First Name

MICHELLE

Middle

DIANNE

Last Name

WILLIS

Business Name

MICHELLE DIANNE WILLIS DO

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

SAINT CHARLES

State

Zip

60175

County

KANE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/20/2009