KENNETH WAGNER ANDERSON III MD Medical Doctor License verification

KENNETH WAGNER ANDERSON III MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036059551

License Status

NOT RENEWED

Business

First Name

KENNETH

Middle

WAGNER

Last Name

ANDERSON

Suffix

III MD

Business Name

KENNETH WAGNER ANDERSON III MD

Original Issue Date

10/26/1979

Effective Date

09/14/2017

Expiration Date

09/30/2020

City

HOMER GLEN

State

Zip

60491

County

WILL

Ever Disciplined

LastModifiedDate

01/14/2021

Case Number

2016008380

Action

Suspension

Discipline Start Date

12/14/2020

Discipline Reason

physician and surgeon license indefinitely suspended due to Medicare privileges being revoked in February 2017 after failing to provide CMS access to documentation.