MARK WISEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108985

License Status

NOT RENEWED

Business

First Name

MARK

Last Name

WISEN

Suffix

Business Name

MARK WISEN MD

Original Issue Date

04/10/2003

Effective Date

04/10/2003

Expiration Date

07/31/2005

City

BLOOMINGTON

State

Zip

47401

County

INDIANA

Ever Disciplined

LastModifiedDate

10/09/2006