LENNI R FUGAZY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002149

License Status

NOT RENEWED

Business

First Name

LENNI

Middle

Last Name

FUGAZY

Business Name

LENNI R FUGAZY

Original Issue Date

10/23/2003

Effective Date

01/23/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

06/23/2016