KENNETH WAGNER ANDERSON III MD Medical Doctor License verification

Business Entity

INOPERATIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

INOPERATIVE

Business

First Name

KENNETH

Middle

WAGNER

Last Name

ANDERSON

Suffix

III MD

Business Name

KENNETH WAGNER ANDERSON III MD

Original Issue Date

01/01/1997

Effective Date

09/14/2017

Expiration Date

09/30/2020

City

ORLAND PARK

State

Zip

60462

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020