RICHARD JACOB FANTUS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065371

License Status

CANCELLED

Business

Title

First Name

RICHARD

Middle

JACOB

Last Name

FANTUS

Business Name

RICHARD JACOB FANTUS MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2017

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

03/03/2015