MARTIN NICOLAS WIJKSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

MARTIN

Middle

NICOLAS

Last Name

WIJKSTROM

Suffix

Business Name

MARTIN NICOLAS WIJKSTROM MD

Original Issue Date

05/15/2008

Effective Date

05/15/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011