MITCHELL FAGAN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079694

License Status

CANCELLED

Business

Title

First Name

MITCHELL

Last Name

FAGAN

Business Name

MITCHELL FAGAN DO

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

03/19/2025