DAWN MARIE WIESE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001039

License Status

NOT RENEWED

Business

First Name

DAWN

Middle

MARIE

Last Name

WIESE

Business Name

DAWN MARIE WIESE

Original Issue Date

04/20/2015

Effective Date

04/20/2015

Expiration Date

05/19/2015

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Gastroenterology

Ever Disciplined

LastModifiedDate

01/07/2016