AMANDA CLARK WIDING MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148645

License Status

INACTIVE

Business

Title

First Name

AMANDA

Middle

CLARK

Last Name

WIDING

Business Name

AMANDA CLARK WIDING MD

Original Issue Date

03/19/2019

Effective Date

03/19/2019

Expiration Date

09/30/2020

City

MILWAUKEE

State

Zip

53202

Ever Disciplined

LastModifiedDate

04/05/2020