DIANE E WALLIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

NOT RENEWED

Business

First Name

DIANE E

Last Name

WALLIS

Suffix

Business Name

DIANE E WALLIS MD

Original Issue Date

10/02/1981

Effective Date

05/23/2017

Expiration Date

09/30/2020

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021