LARISSA WIETLISBACH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125082534

License Status

ACTIVE

Business

Title

First Name

LARISSA

Last Name

WIETLISBACH

Business Name

LARISSA WIETLISBACH MD

Original Issue Date

06/24/2026

Effective Date

06/24/2026

Expiration Date

06/23/2029

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Plastic Surgery - Integrated

Ever Disciplined

LastModifiedDate

12/17/2025