PHYLLIS T WISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036079913

License Status

NOT RENEWED

Business

First Name

PHYLLIS T

Last Name

WISE

Suffix

Business Name

PHYLLIS T WISE MD

Original Issue Date

05/21/1990

Effective Date

05/21/1990

Expiration Date

07/31/1993

City

INDIANAPOLIS

State

Zip

46241

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006