KIMBERLY DENISE WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

ACTIVE

Business

Title

First Name

KIMBERLY

Middle

DENISE

Last Name

WALLACE

Business Name

KIMBERLY DENISE WALLACE MD

Original Issue Date

04/24/2025

Effective Date

04/24/2025

Expiration Date

07/31/2026

City

BLOOMFIELD HILLS

State

Zip

48302

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/24/2025