TIMOTHY DANIEL FAGEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

Title

First Name

TIMOTHY

Middle

DANIEL

Last Name

FAGEN

Business Name

TIMOTHY DANIEL FAGEN DO

Original Issue Date

02/24/2015

Effective Date

02/24/2015

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60605

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020