DIANA WALLER SUCHOFF Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000223

License Status

NOT RENEWED

Business

First Name

DIANA WALLER

Last Name

SUCHOFF

Business Name

DIANA WALLER SUCHOFF

Original Issue Date

11/02/1981

Effective Date

11/02/1981

Expiration Date

03/01/1992

City

CHICAGO

State

Zip

60625

County

COOK

Ever Disciplined

LastModifiedDate

09/26/2006