THOMAS RUDOLPH WAGNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068981

License Status

EXPIRED

Business

Title

First Name

THOMAS

Middle

RUDOLPH

Last Name

WAGNER

Business Name

THOMAS RUDOLPH WAGNER MD

Original Issue Date

06/24/2016

Effective Date

06/24/2016

Expiration Date

06/23/2019

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/02/2019