MICHAEL T WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

Last Name

WAGNER

Suffix

Business Name

MICHAEL T WAGNER MD

Original Issue Date

07/12/1999

Effective Date

05/31/2023

Expiration Date

07/31/2026

City

NAPERVILLE

State

Zip

60563

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/31/2023