ELLIOTT S WISE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004456

License Status

NOT RENEWED

Business

First Name

ELLIOTT

Middle

Last Name

WISE

Business Name

ELLIOTT S WISE

Original Issue Date

09/17/2012

Effective Date

09/17/2012

Expiration Date

03/01/2014

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Ever Disciplined

LastModifiedDate

12/23/2015