FATIMA A BALLOUT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068755

License Status

CANCELLED

Business

Title

First Name

FATIMA

Middle

Last Name

BALLOUT

Business Name

FATIMA A BALLOUT MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/09/2016