BARBARA WIETIES MALM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

First Name

BARBARA WIETIES

Last Name

MALM

Business Name

BARBARA WIETIES MALM

Original Issue Date

06/30/1986

Effective Date

05/11/2011

Expiration Date

07/31/2014

City

BLUE ISLAND

State

Zip

60406

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014