License holder summary

Mark R. Fantauzzi is a Controlled Substance Registration-Osteopathic Physician licensed to practice in Indiana. The address on file for Mark R. Fantauzzi is Parkview Hosp Medical Staff Office, 2200 Randallia, Fort Wayne IN 46815. This licensed professional license is not current. The license was granted 01/23/1997 and expired on 06/30/2011.

Indiana

Professional Licensing Agency

Mark R. Fantauzzi
Controlled Substance Registration-Osteopathic Physician
License number
02001815B
Date granted
01/23/1997
Date expires
06/30/2011
Class
Controlled Substance Registration-Osteopathic Physician
Status
Expired
Address
Parkview Hosp Medical Staff Office, 2200 Randallia, Fort Wayne IN 46815
indianalicensing.org
ID 5800656
LAST UPDATED 2024-03-25 02:00:33 UTC

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