DANIEL WADE FODOR MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042370

License Status

CANCELLED

Business

First Name

DANIEL

Middle

WADE

Last Name

FODOR

Suffix

Business Name

DANIEL WADE FODOR MD

Original Issue Date

06/28/2001

Effective Date

06/28/2001

Expiration Date

06/27/2002

City

CHICAGO

State

Zip

60640

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006