MICHAEL WARREN FOUNTAIN DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045987

License Status

EXPIRED

Business

First Name

MICHAEL

Middle

WARREN

Last Name

FOUNTAIN

Suffix

Business Name

MICHAEL WARREN FOUNTAIN DO

Original Issue Date

06/19/2003

Effective Date

06/19/2003

Expiration Date

06/30/2009

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Urological Surgery

Ever Disciplined

LastModifiedDate

07/15/2009