CHRISTIAN R DEFAZIO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125031008

License Status

EXPIRED

Business

First Name

CHRISTIAN R

Last Name

DEFAZIO

Business Name

CHRISTIAN R DEFAZIO

Original Issue Date

05/09/1994

Effective Date

05/09/1994

Expiration Date

06/30/1997

City

CHICAGO

State

Zip

60616

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006