MAHVEEN ETHEZAZ Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

ACTIVE

Business

First Name

MAHVEEN

Last Name

ETHEZAZ

Business Name

MAHVEEN ETHEZAZ

Original Issue Date

03/13/2020

Effective Date

07/25/2023

Expiration Date

07/31/2026

City

WOODRIDGE

State

Zip

60517

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/25/2023