JOHN FIKRY MITYAS IBRAHIM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

ACTIVE

Business

Title

First Name

JOHN

Middle

FIKRY MITYAS

Last Name

IBRAHIM

Business Name

JOHN FIKRY MITYAS IBRAHIM MD

Original Issue Date

12/04/2018

Effective Date

05/13/2023

Expiration Date

07/31/2026

City

BURR RIDGE

State

Zip

60527

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/13/2023