KURT J WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

KURT J

Last Name

WAGNER

Suffix

Business Name

KURT J WAGNER MD

Original Issue Date

01/19/1984

Effective Date

04/30/2014

Expiration Date

07/31/2017

City

PALOS HEIGHTS

State

Zip

60463

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020