MALIK GHANNAM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

ACTIVE

Business

Title

First Name

MALIK

Last Name

GHANNAM

Business Name

MALIK GHANNAM MD

Original Issue Date

01/08/2025

Effective Date

01/08/2025

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/08/2025