KATHLEEN E WIDES Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

First Name

KATHLEEN E

Last Name

WIDES

Business Name

KATHLEEN E WIDES

Original Issue Date

08/01/1984

Effective Date

08/01/1984

Expiration Date

07/31/1996

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006