LISA BETH VANWAGNER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052543

License Status

CANCELLED

Business

First Name

LISA

Middle

BETH

Last Name

VANWAGNER

Suffix

Business Name

LISA BETH VANWAGNER MD

Original Issue Date

06/18/2007

Effective Date

06/18/2007

Expiration Date

06/17/2010

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/26/2010