GABRIEL ABRAHAM WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

ACTIVE

Business

Title

First Name

GABRIEL

Middle

ABRAHAM

Last Name

WALLACE

Business Name

GABRIEL ABRAHAM WALLACE MD

Original Issue Date

02/23/2017

Effective Date

06/02/2023

Expiration Date

07/31/2026

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/02/2023