DUSTIN JOHN FANCIULLO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048065

License Status

EXPIRED

Business

First Name

DUSTIN

Middle

JOHN

Last Name

FANCIULLO

Suffix

Business Name

DUSTIN JOHN FANCIULLO MD

Original Issue Date

06/24/2007

Effective Date

06/24/2007

Expiration Date

06/23/2009

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

07/15/2009