MATTHEW C DIFAZIO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028214

License Status

EXPIRED

Business

First Name

MATTHEW

Middle

Last Name

DIFAZIO

Business Name

MATTHEW C DIFAZIO

Original Issue Date

05/18/1992

Effective Date

05/18/1992

Expiration Date

06/23/1996

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatric Pathology

Ever Disciplined

LastModifiedDate

09/22/2006