NATHANIEL RICHARD WISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

Title

First Name

NATHANIEL

Middle

RICHARD

Last Name

WISE

Business Name

NATHANIEL RICHARD WISE MD

Original Issue Date

11/02/2022

Effective Date

11/02/2022

Expiration Date

07/31/2023

City

HARVEY

State

Zip

60426

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023