MICHAEL WOLFGANG LAKE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063687

License Status

EXPIRED

Business

Title

First Name

MICHAEL

Middle

WOLFGANG

Last Name

LAKE

Business Name

MICHAEL WOLFGANG LAKE MD

Original Issue Date

06/22/2013

Effective Date

06/22/2013

Expiration Date

06/21/2016

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

08/16/2016