THEODORE W WAGENKNECHT JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****24

License Status

NOT RENEWED

Business

First Name

THEODORE W

Last Name

WAGENKNECHT JR

Suffix

Business Name

THEODORE W WAGENKNECHT JR MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1996

City

STREATOR

State

Zip

61364

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006