ELMIRA S BASALY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

ACTIVE

Business

Title

First Name

ELMIRA

Middle

Last Name

BASALY

Business Name

ELMIRA S BASALY MD

Original Issue Date

10/14/2015

Effective Date

06/04/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61636

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/04/2023