DAVID KIETH WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036063166

License Status

NOT RENEWED

Business

First Name

DAVID KIETH

Last Name

WAGNER

Suffix

Business Name

DAVID KIETH WAGNER MD

Original Issue Date

09/10/1981

Effective Date

09/10/1981

Expiration Date

07/31/1990

City

RIVER FOREST

State

Zip

60305

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006