COLLEEN DIANE FANT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

ACTIVE

Business

Title

First Name

COLLEEN

Middle

DIANE

Last Name

FANT

Business Name

COLLEEN DIANE FANT MD

Original Issue Date

04/07/2016

Effective Date

06/15/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60642

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/15/2023