MICHAEL T WAGNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036393

License Status

EXPIRED

Business

First Name

MICHAEL

Middle

Last Name

WAGNER

Suffix

Business Name

MICHAEL T WAGNER MD

Original Issue Date

05/30/1997

Effective Date

05/30/1997

Expiration Date

06/30/2000

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006