CHRISTIAN R DEFAZIO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

First Name

CHRISTIAN R

Last Name

DEFAZIO

Business Name

CHRISTIAN R DEFAZIO

Original Issue Date

08/13/1996

Effective Date

08/13/1996

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006