ANDY AGEN DAVIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

First Name

ANDY AGEN

Last Name

DAVIS

Suffix

Business Name

ANDY AGEN DAVIS MD

Original Issue Date

01/01/1997

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021