LENNI R FUGAZY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

NOT RENEWED

Business

First Name

LENNI

Middle

Last Name

FUGAZY

Business Name

LENNI R FUGAZY

Original Issue Date

02/09/2004

Effective Date

01/23/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

06/23/2016