DAVID CARLO DE FAZIO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050310

License Status

CANCELLED

Business

First Name

DAVID

Middle

CARLO

Last Name

DE FAZIO

Suffix

Business Name

DAVID CARLO DE FAZIO MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006