FATIMA A BALLOUT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

NOT RENEWED

Business

Title

First Name

FATIMA

Middle

Last Name

BALLOUT

Business Name

FATIMA A BALLOUT MD

Original Issue Date

04/18/2019

Effective Date

04/18/2019

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021