FANNIE W SU Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036104363

License Status

NOT RENEWED

Business

First Name

FANNIE

Middle

Last Name

Business Name

FANNIE W SU

Original Issue Date

03/19/2001

Effective Date

03/19/2001

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006