LISA WALLACE D.O. Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036177164

License Status

ACTIVE

Business

Title

D.O.

First Name

LISA

Last Name

WALLACE

Business Name

LISA WALLACE D.O.

Original Issue Date

09/15/2025

Effective Date

09/15/2025

Expiration Date

07/31/2026

City

GRAND RAPIDS

State

Zip

49507

Ever Disciplined

LastModifiedDate

01/16/2026