LAURA FASULO ROSS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

First Name

LAURA

Middle

FASULO

Last Name

ROSS

Suffix

Business Name

LAURA FASULO ROSS MD

Original Issue Date

03/12/2009

Effective Date

03/12/2009

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011