MICHAEL ALAN FULLER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083214

License Status

ACTIVE

Business

Title

First Name

MICHAEL

Middle

ALAN

Last Name

FULLER

Business Name

MICHAEL ALAN FULLER MD

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2027

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/03/2024