BRIAN LUIT WAGENAAR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141019

License Status

ACTIVE

Business

First Name

BRIAN

Middle

LUIT

Last Name

WAGENAAR

Suffix

Business Name

BRIAN LUIT WAGENAAR MD

Original Issue Date

06/22/2016

Effective Date

04/27/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

04/27/2023