COLLEEN DIANE FANT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036140292

License Status

ACTIVE

Business

Title

First Name

COLLEEN

Middle

DIANE

Last Name

FANT

Business Name

COLLEEN DIANE FANT MD

Original Issue Date

04/07/2016

Effective Date

06/15/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60625

County

COOK

Ever Disciplined

LastModifiedDate

06/15/2023