GOLAREH FAZILAT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046713

License Status

CANCELLED

Business

First Name

GOLAREH

Last Name

FAZILAT

Suffix

Business Name

GOLAREH FAZILAT MD

Original Issue Date

07/01/2003

Effective Date

07/01/2003

Expiration Date

06/30/2006

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

09/22/2006