FARDAD MASSOUMI-BAVIL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043598

License Status

EXPIRED

Business

First Name

FARDAD

Last Name

MASSOUMI-BAVIL

Suffix

Business Name

FARDAD MASSOUMI-BAVIL MD

Original Issue Date

11/16/2004

Effective Date

11/16/2004

Expiration Date

03/15/2005

City

CHICAGO

State

Zip

60608

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006