DUSTIN RYAN FRAIDENBURG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056970

License Status

CANCELLED

Business

Title

First Name

DUSTIN

Middle

RYAN

Last Name

FRAIDENBURG

Business Name

DUSTIN RYAN FRAIDENBURG MD

Original Issue Date

06/24/2009

Effective Date

06/24/2009

Expiration Date

06/23/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/16/2009