MALCOLM MARAZBAN VANDREVALA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066881

License Status

CANCELLED

Business

Title

First Name

MALCOLM

Middle

MARAZBAN

Last Name

VANDREVALA

Business Name

MALCOLM MARAZBAN VANDREVALA MD

Original Issue Date

06/25/2015

Effective Date

06/25/2015

Expiration Date

06/24/2018

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

04/02/2015