NELLY YACOUB KAZZAZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

Title

First Name

NELLY

Middle

YACOUB

Last Name

KAZZAZ

Business Name

NELLY YACOUB KAZZAZ MD

Original Issue Date

12/01/2008

Effective Date

12/01/2008

Expiration Date

07/31/2011

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011