FATIMA A BALLOUT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036149080

License Status

NOT RENEWED

Business

Title

First Name

FATIMA

Middle

Last Name

BALLOUT

Business Name

FATIMA A BALLOUT MD

Original Issue Date

04/18/2019

Effective Date

04/30/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

11/30/2023