MARTIN KEVIN WAKEHAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

CANCELLED

Business

Title

First Name

MARTIN

Middle

KEVIN

Last Name

WAKEHAM

Business Name

MARTIN KEVIN WAKEHAM MD

Original Issue Date

10/18/2002

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011