DAVID MICHAEL FASTENBERG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

DAVID MICHAEL

Last Name

FASTENBERG

Suffix

Business Name

DAVID MICHAEL FASTENBERG MD

Original Issue Date

01/01/1997

Expiration Date

01/01/1997

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006