DIANA T WIDICUS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

NOT RENEWED

Business

First Name

DIANA T

Last Name

WIDICUS

Suffix

Business Name

DIANA T WIDICUS MD

Original Issue Date

01/01/1997

Effective Date

05/28/2020

Expiration Date

07/31/2023

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023