DUSTIN JOHN FANCIULLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036119439

License Status

NOT RENEWED

Business

First Name

DUSTIN

Middle

JOHN

Last Name

FANCIULLO

Suffix

Business Name

DUSTIN JOHN FANCIULLO MD

Original Issue Date

09/25/2007

Effective Date

05/28/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

11/14/2011