GABRIEL VAN DE WALLE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076481

License Status

ACTIVE

Business

First Name

GABRIEL

Last Name

VAN DE WALLE

Business Name

GABRIEL VAN DE WALLE

Original Issue Date

06/24/2023

Effective Date

06/24/2023

Expiration Date

06/23/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

01/20/2023