WALLACE KENJI NAKAGAWA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

First Name

WALLACE KENJI

Last Name

NAKAGAWA

Suffix

Business Name

WALLACE KENJI NAKAGAWA MD

Original Issue Date

04/08/1987

Effective Date

04/08/1987

Expiration Date

07/31/1990

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006