TAMARA FATIANOV Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105809

License Status

INACTIVE

Business

First Name

TAMARA

Last Name

FATIANOV

Business Name

TAMARA FATIANOV

Original Issue Date

11/07/2001

Effective Date

11/07/2001

Expiration Date

07/31/2002

City

WILLOWBROOK

State

Zip

60514

County

WILL

Ever Disciplined

LastModifiedDate

10/09/2006