MOWAFFAK MARK CHICHAKLY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

NOT RENEWED

Business

First Name

MOWAFFAK MARK

Last Name

CHICHAKLY

Suffix

Business Name

MOWAFFAK MARK CHICHAKLY MD

Original Issue Date

12/24/1990

Effective Date

12/24/1990

Expiration Date

07/31/2002

City

EAST ST LOUIS

State

Zip

62205

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006