ANDREW BRIAN FAGAN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077318

License Status

EXPIRED

Business

Title

First Name

ANDREW

Middle

BRIAN

Last Name

FAGAN

Business Name

ANDREW BRIAN FAGAN MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2022

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Mechanical Cardiac Support and Transplant

Ever Disciplined

LastModifiedDate

10/11/2022