AMY WAGENAAR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

ACTIVE

Business

Title

First Name

AMY

Last Name

WAGENAAR

Business Name

AMY WAGENAAR MD

Original Issue Date

05/26/2023

Effective Date

05/26/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/26/2023