LEE MICHAEL TISA DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016003410

License Status

NOT RENEWED

Business

First Name

LEE

Middle

MICHAEL

Last Name

TISA

Suffix

DPM

Business Name

LEE MICHAEL TISA DPM

Original Issue Date

06/17/1982

Effective Date

11/26/2014

Expiration Date

01/31/2017

City

LAKE GENEVA

State

Zip

53147

County

WISCONSIN

Ever Disciplined

LastModifiedDate

03/27/2017

Case Number

2014010655

Action

Suspension

Discipline Start Date

01/24/2015

Discipline Reason

Failure to file and/or pay Illinois state income taxes.