MUHAMMAD REZA PERKASA MARWALI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

ACTIVE

Business

Title

First Name

MUHAMMAD

Middle

REZA PERKASA

Last Name

MARWALI

Business Name

MUHAMMAD REZA PERKASA MARWALI MD

Original Issue Date

01/04/2017

Effective Date

04/09/2023

Expiration Date

07/31/2026

City

WOODRIDGE

State

Zip

60517

County

GRUNDY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/09/2023