DIMITRIOS I FANOPOULOS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

ACTIVE

Business

Title

First Name

DIMITRIOS

Middle

Last Name

FANOPOULOS

Business Name

DIMITRIOS I FANOPOULOS MD

Original Issue Date

08/19/1996

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023