HEATHER A FAGAN Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039177

License Status

CANCELLED

Business

First Name

HEATHER

Middle

Last Name

FAGAN

Business Name

HEATHER A FAGAN

Original Issue Date

06/24/1999

Effective Date

06/24/1999

Expiration Date

06/23/2002

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006