MARK W DECLUTE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077158

License Status

INACTIVE

Business

First Name

MARK W

Last Name

DECLUTE

Suffix

Business Name

MARK W DECLUTE MD

Original Issue Date

06/18/1988

Effective Date

06/18/1988

Expiration Date

07/31/2002

City

MARATHON

State

Zip

54448

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006