DOUGLAS SHANE WISEMAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

ACTIVE

Business

Title

First Name

DOUGLAS

Middle

SHANE

Last Name

WISEMAN

Business Name

DOUGLAS SHANE WISEMAN MD

Original Issue Date

10/03/2019

Effective Date

06/26/2023

Expiration Date

07/31/2026

City

HINSDALE

State

Zip

60521

County

MONTGOMERY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/26/2023