ANDREW Q DE FUNIAK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040747

License Status

EXPIRED

Business

First Name

ANDREW

Middle

Last Name

DE FUNIAK

Business Name

ANDREW Q DE FUNIAK

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006