MICHAEL ANDREW WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

ANDREW

Last Name

WAGNER

Suffix

Business Name

MICHAEL ANDREW WAGNER MD

Original Issue Date

09/03/1998

Effective Date

06/08/2017

Expiration Date

09/30/2020

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021