IFATH G BASHIRUDDIN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

First Name

IFATH G

Last Name

BASHIRUDDIN

Suffix

Business Name

IFATH G BASHIRUDDIN MD

Original Issue Date

05/19/1994

Effective Date

06/27/2023

Expiration Date

07/31/2026

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/27/2023