BRIAN LUIT WAGENAAR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

ACTIVE

Business

First Name

BRIAN

Middle

LUIT

Last Name

WAGENAAR

Suffix

Business Name

BRIAN LUIT WAGENAAR MD

Original Issue Date

06/22/2016

Effective Date

04/27/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/27/2023