SUSAN MICHELLE FANAPOUR DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039184

License Status

EXPIRED

Business

First Name

SUSAN

Middle

MICHELLE

Last Name

FANAPOUR

Suffix

Business Name

SUSAN MICHELLE FANAPOUR DO

Original Issue Date

06/21/1999

Effective Date

06/21/1999

Expiration Date

06/20/2002

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

09/22/2006