CHARITY ANNELIEN WIP MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

Title

First Name

CHARITY

Middle

ANNELIEN

Last Name

WIP

Business Name

CHARITY ANNELIEN WIP MD

Original Issue Date

09/17/2015

Effective Date

09/17/2015

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017