ADAM N WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058310

License Status

EXPIRED

Business

Title

First Name

ADAM

Middle

Last Name

WALLACE

Business Name

ADAM N WALLACE MD

Original Issue Date

06/14/2010

Effective Date

06/14/2010

Expiration Date

06/13/2011

City

BERWYN

State

Zip

60402

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

07/19/2011