MATTHEW SHAWN MALLARD MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

ACTIVE

Business

Title

First Name

MATTHEW

Middle

SHAWN

Last Name

MALLARD

Business Name

MATTHEW SHAWN MALLARD MD

Original Issue Date

07/23/2024

Effective Date

07/23/2024

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/23/2024