DAVID KIETH WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

First Name

DAVID KIETH

Last Name

WAGNER

Suffix

Business Name

DAVID KIETH WAGNER MD

Original Issue Date

08/25/1987

Effective Date

08/25/1987

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

09/26/2006