ANDY C FAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

ANDY

Middle

Last Name

FAN

Suffix

Business Name

ANDY C FAN MD

Original Issue Date

02/24/2005

Effective Date

02/24/2005

Expiration Date

07/31/2008

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008