MITCHEL ALAN WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036166029

License Status

ACTIVE

Business

Title

First Name

MITCHEL

Middle

ALAN

Last Name

WAGNER

Business Name

MITCHEL ALAN WAGNER DO

Original Issue Date

07/20/2023

Effective Date

07/20/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

County

PEORIA

Ever Disciplined

LastModifiedDate

06/07/2023