MATTHEW THOMAS DESTEFANI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066900

License Status

CANCELLED

Business

Title

First Name

MATTHEW

Middle

THOMAS

Last Name

DESTEFANI

Business Name

MATTHEW THOMAS DESTEFANI MD

Original Issue Date

06/22/2015

Effective Date

06/22/2015

Expiration Date

06/21/2018

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/27/2015