AMANDA CLARK WIDING MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

INACTIVE

Business

Title

First Name

AMANDA

Middle

CLARK

Last Name

WIDING

Business Name

AMANDA CLARK WIDING MD

Original Issue Date

05/27/2020

Effective Date

05/27/2020

Expiration Date

07/31/2023

City

MILWAUKEE

State

Zip

53226

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/27/2020