DANA C FAIRBANKS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110554

License Status

NOT RENEWED

Business

First Name

DANA

Middle

Last Name

FAIRBANKS

Business Name

DANA C FAIRBANKS

Original Issue Date

12/08/2003

Effective Date

07/07/2011

Expiration Date

07/31/2014

City

DES PLAINES

State

Zip

60016

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014