DANA C FAIRBANKS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

DANA

Middle

Last Name

FAIRBANKS

Business Name

DANA C FAIRBANKS

Original Issue Date

03/09/2004

Effective Date

08/08/2011

Expiration Date

07/31/2014

City

WILMETTE

State

Zip

60091

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014