TIMOTHY MICHAEL WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036164331

License Status

ACTIVE

Business

Title

First Name

TIMOTHY

Middle

MICHAEL

Last Name

WALLACE

Business Name

TIMOTHY MICHAEL WALLACE MD

Original Issue Date

04/11/2023

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

WEST ALLIS

State

Zip

53227

Ever Disciplined

LastModifiedDate

04/19/2024