BURGESS C WILSON Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

BURGESS C

Last Name

WILSON

Business Name

BURGESS C WILSON

Original Issue Date

05/25/2004

Effective Date

03/05/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021