AZITA MOALEMI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047956

License Status

CANCELLED

Business

First Name

AZITA

Last Name

MOALEMI

Suffix

Business Name

AZITA MOALEMI MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2006

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006