MINA HAFZALAH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

First Name

MINA

Last Name

HAFZALAH

Business Name

MINA HAFZALAH

Original Issue Date

12/12/2006

Effective Date

05/10/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021