EGIL FOSSLIEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

First Name

EGIL

Last Name

FOSSLIEN

Suffix

Business Name

EGIL FOSSLIEN MD

Original Issue Date

08/16/1983

Effective Date

06/24/2011

Expiration Date

07/31/2014

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017