ALEXEI MARTIN WAGNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057807

License Status

EXPIRED

Business

Title

First Name

ALEXEI

Middle

MARTIN

Last Name

WAGNER

Business Name

ALEXEI MARTIN WAGNER MD

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2013

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

10/07/2013