MATTHEW A FACKTOR Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034923

License Status

EXPIRED

Business

First Name

MATTHEW

Middle

Last Name

FACKTOR

Business Name

MATTHEW A FACKTOR

Original Issue Date

06/08/1996

Effective Date

06/08/1996

Expiration Date

06/30/1999

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006