HEATHER A FAGAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

Last Name

FAGAN

Business Name

HEATHER A FAGAN

Original Issue Date

08/29/2002

Effective Date

04/26/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014