RANDI R WAGNER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125024016

License Status

EXPIRED

Business

First Name

RANDI

Middle

Last Name

WAGNER

Business Name

RANDI R WAGNER

Original Issue Date

06/02/1989

Effective Date

06/02/1989

Expiration Date

06/22/1990

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006