JENNIFER ROSE DEFAZIO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036131694

License Status

NOT RENEWED

Business

Title

First Name

JENNIFER

Middle

ROSE

Last Name

DEFAZIO

Business Name

JENNIFER ROSE DEFAZIO MD

Original Issue Date

11/07/2012

Effective Date

06/03/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017