KATHLEEN MARIE WIESE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

ACTIVE

Business

First Name

KATHLEEN

Middle

MARIE

Last Name

WIESE

Suffix

Business Name

KATHLEEN MARIE WIESE DO

Original Issue Date

06/08/2006

Effective Date

06/23/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/23/2023