WALLACE KENJI NAKAGAWA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

First Name

WALLACE KENJI

Last Name

NAKAGAWA

Suffix

Business Name

WALLACE KENJI NAKAGAWA MD

Original Issue Date

08/13/1981

Effective Date

08/13/1981

Expiration Date

07/31/1993

City

VILLA GROVE

State

Zip

61956

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006