DAFINA WISE ALLEN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060514

License Status

CANCELLED

Business

Title

First Name

DAFINA

Middle

WISE

Last Name

ALLEN

Business Name

DAFINA WISE ALLEN MD

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2014

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/14/2011