DENISE DEBRA DEWALD MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036129610

License Status

INACTIVE

Business

Title

First Name

DENISE

Middle

DEBRA

Last Name

DEWALD

Business Name

DENISE DEBRA DEWALD MD

Original Issue Date

02/14/2012

Effective Date

09/28/2020

Expiration Date

07/31/2023

City

POLK

State

Zip

44866

County

COOK

Ever Disciplined

LastModifiedDate

04/04/2023