TARIQ ENEZATE 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

Title

First Name

TARIQ

Last Name

ENEZATE

Business Name

TARIQ ENEZATE MD

Original Issue Date

08/19/2021

Effective Date

06/16/2023

Expiration Date

07/31/2026

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/16/2023