HEATHER A FAGAN Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036107219

License Status

INACTIVE

Business

First Name

HEATHER

Middle

Last Name

FAGAN

Business Name

HEATHER A FAGAN

Original Issue Date

06/13/2002

Effective Date

04/26/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

06/19/2014