BARBARA WIETIES MALM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

BARBARA WIETIES

Last Name

MALM

Business Name

BARBARA WIETIES MALM

Original Issue Date

06/01/1984

Effective Date

06/01/1984

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011