JASON R FANGUSARO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105562

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

FANGUSARO

Suffix

Business Name

JASON R FANGUSARO MD

Original Issue Date

09/12/2001

Effective Date

04/13/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021