KATHERINE NICOLE WAGNER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063083

License Status

CANCELLED

Business

Title

First Name

KATHERINE

Middle

NICOLE

Last Name

WAGNER

Business Name

KATHERINE NICOLE WAGNER MD

Original Issue Date

06/25/2013

Effective Date

06/25/2013

Expiration Date

06/24/2014

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/06/2013