PATRICK J WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

PATRICK J

Last Name

WALLACE

Suffix

Business Name

PATRICK J WALLACE MD

Original Issue Date

06/20/1994

Effective Date

06/20/1994

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006