FATIMA A BALLOUT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

NOT RENEWED

Business

Title

First Name

FATIMA

Middle

Last Name

BALLOUT

Business Name

FATIMA A BALLOUT MD

Original Issue Date

03/22/2021

Effective Date

03/22/2021

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023