ENAYATOLLAH OSANLOO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

ENAYATOLLAH

Last Name

OSANLOO

Suffix

Business Name

ENAYATOLLAH OSANLOO MD

Original Issue Date

01/01/1997

Effective Date

06/02/2014

Expiration Date

07/31/2017

City

NAPERVILLE

State

Zip

60540

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020