MICHAEL WALLER MD (Credential# 553843) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is November 30, 1999. The license expiration date date is December 31, 2000. The license status is INACTIVE.
MICHAEL WALLER MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.036251. The credential type is physician/surgeon. The effective date is November 30, 1999. The expiration date is December 31, 2000. The business address is 105 Richards Ave Unit #1302, Norwalk, CT 06854-1683. The current status is inactive.
| Licensee Name | MICHAEL WALLER MD |
| Credential ID | 553843 |
| Credential Number | 1.036251 |
| Credential Type | Physician/Surgeon |
| Business Address |
105 Richards Ave Unit #1302 Norwalk CT 06854-1683 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1997-07-25 |
| Effective Date | 1999-11-30 |
| Expiration Date | 2000-12-31 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 183871 | CSP.0025813 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 - 2000-02-28 | INACTIVE |
| Street Address | 105 RICHARDS AVE UNIT #1302 |
| City | NORWALK |
| State | CT |
| Zip Code | 06854-1683 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Devon Nicole Miles | 105 Richards Ave Unit 1312, Norwalk, CT 06854-1683 | Master's Level Social Worker | 2020-07-01 ~ 2021-06-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Vanessa Benitez | 190 Ely Ave., Norwalk, CT 06854 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Jessica Christina Andraszek | 7a Edgewood St, Norwalk, CT 06854 | Registered Nurse | ~ |
| Farrah Marin | 63 Bayview Avenue, Norwalk, CT 06854 | Master's Level Social Worker | ~ |
| Irma M Ross | 30 Lenox Ave, Norwalk, CT 06854 | Professional Counselor | 2020-08-01 ~ 2021-07-31 |
| Community Plates Inc. | 165 Water Street, Norwalk, CT 06854 | Public Charity | 2020-12-01 ~ 2021-11-30 |
| Roberto Arzuaga · West Cedar Grocery | 155 West Cedar St, Norwalk, CT 06854 | Grocery Beer | 2020-07-17 ~ 2021-07-16 |
| Faith Kiriakidis | 130 Flax Hill Road, Norwalk, CT 06854 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Andrew Gotlin | 1 North Water Street, Norwalk, CT 06854 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Shunxia Guan | 360 Connecticut Ste 2, Norwalk, CT 06854 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Zhenyu Quan | 360 Connecticut Ave Suit 2, Norwalk, CT 06854 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Find all Licenses in zip 06854 | |||
| City | NORWALK |
| Zip Code | 06854 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + NORWALK |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brendan Michael Levy | 41 Waller St Unit 310, San Francisco, CA 94102-6285 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| William Blackwell | 41 Waller St, San Francisco, CA 94102 | Physician/surgeon | 2020-03-06 ~ 2021-01-31 |
| Scott Waller Md | 2 Trap Falls Rd Ste 404, Shelton, CT 06484-4665 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Michael M Waller | 15 Donna Dr #b-3, New Haven, CT 06513 | Occupational Therapist | 1995-06-07 ~ 1997-07-31 |
| Michael I Waller | 201 Romford Rd, Washington Depot, CT 06794-1300 | Athletic Trainer | 2020-07-01 ~ 2021-06-30 |
| Michael G Kovac | 41 Waller St., San Francisco, CA 94121 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Waller Laurelwood LLC | 550 North Main St, Southington, CT 06489 | New Home Construction Contractor | 2013-10-01 ~ 2015-09-30 |
| Page Waller | 96 Route 37, New Fairfield, CT 06812 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Michael V W Waller | 73 Lyman Road, Middlefield, CT 06455 | Notary Public Appointment | 2011-07-01 ~ 2016-06-30 |
| Michael Scott Waller | 157 Breezy Corners Rd, Portland, CT 06480-1781 | Honey Bee Registration | 2020-04-24 ~ 2020-09-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).