CHRISTIAN R DEFAZIO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093931

License Status

NOT RENEWED

Business

First Name

CHRISTIAN R

Last Name

DEFAZIO

Business Name

CHRISTIAN R DEFAZIO

Original Issue Date

08/09/1996

Effective Date

08/09/1996

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006