EMILY G FANCIULLO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

EMILY

Middle

Last Name

FANCIULLO

Business Name

EMILY G FANCIULLO

Original Issue Date

08/31/2006

Effective Date

05/28/2008

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011