ADAM N WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148822

License Status

ACTIVE

Business

Title

First Name

ADAM

Middle

Last Name

WALLACE

Business Name

ADAM N WALLACE MD

Original Issue Date

03/28/2019

Effective Date

04/20/2023

Expiration Date

07/31/2026

City

MEQUON

State

Zip

53092

Ever Disciplined

LastModifiedDate

04/20/2023