DIANE L FABRICIUS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013966

License Status

EXPIRED

Business

First Name

DIANE L

Last Name

FABRICIUS

Suffix

Business Name

DIANE L FABRICIUS MD

Original Issue Date

06/17/1982

Effective Date

06/17/1982

Expiration Date

06/29/1984

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006