DAVID MICHAEL FASTENBERG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036055500

License Status

NOT RENEWED

Business

First Name

DAVID MICHAEL

Last Name

FASTENBERG

Suffix

Business Name

DAVID MICHAEL FASTENBERG MD

Original Issue Date

08/22/1977

Effective Date

08/22/1977

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006