MICHAEL GREGORY FAZIO DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151550

License Status

ACTIVE

Business

Title

First Name

MICHAEL

Middle

GREGORY

Last Name

FAZIO

Business Name

MICHAEL GREGORY FAZIO DO

Original Issue Date

01/13/2020

Effective Date

07/12/2023

Expiration Date

07/31/2026

City

GLEN CARBON

State

Zip

62034

Ever Disciplined

LastModifiedDate

08/01/2024