BRIAN MICHAEL FAGAN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040762

License Status

EXPIRED

Business

First Name

BRIAN

Middle

MICHAEL

Last Name

FAGAN

Suffix

Business Name

BRIAN MICHAEL FAGAN MD

Original Issue Date

06/12/2000

Effective Date

06/12/2000

Expiration Date

06/11/2003

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

09/22/2006