MARDJAN FOROUTAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043807

License Status

CANCELLED

Business

First Name

MARDJAN

Last Name

FOROUTAN

Suffix

Business Name

MARDJAN FOROUTAN MD

Original Issue Date

10/18/2001

Effective Date

10/18/2001

Expiration Date

10/17/2004

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006