MARTIN KEVIN WAKEHAM MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036103836

License Status

INACTIVE

Business

Title

First Name

MARTIN

Middle

KEVIN

Last Name

WAKEHAM

Business Name

MARTIN KEVIN WAKEHAM MD

Original Issue Date

11/20/2000

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

WAUKESHA

State

Zip

53189

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/07/2011