ANDREW FREDERICK WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

ACTIVE

Business

Title

First Name

ANDREW

Middle

FREDERICK

Last Name

WAGNER

Business Name

ANDREW FREDERICK WAGNER MD

Original Issue Date

08/02/2016

Effective Date

07/23/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/23/2023