MALCOLM MARAZBAN VANDREVALA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

ACTIVE

Business

Title

First Name

MALCOLM

Middle

MARAZBAN

Last Name

VANDREVALA

Business Name

MALCOLM MARAZBAN VANDREVALA MD

Original Issue Date

06/18/2018

Effective Date

08/12/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/12/2023