MARY B FAUSONE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****49

License Status

NOT RENEWED

Business

First Name

MARY B

Last Name

FAUSONE

Suffix

Business Name

MARY B FAUSONE MD

Original Issue Date

05/23/1986

Effective Date

08/20/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023