CHRISTOPHER MICHAEL WAGNER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074028

License Status

CANCELLED

Business

Title

First Name

CHRISTOPHER

Middle

MICHAEL

Last Name

WAGNER

Business Name

CHRISTOPHER MICHAEL WAGNER MD

Original Issue Date

06/25/2019

Effective Date

06/25/2019

Expiration Date

06/24/2022

City

PARK RIDGE

State

Zip

60068

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/15/2019