JASON R FANGUSARO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

FANGUSARO

Suffix

Business Name

JASON R FANGUSARO MD

Original Issue Date

10/16/2001

Effective Date

04/13/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021