FARDAD MASSOUMI-BAVIL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

NOT RENEWED

Business

First Name

FARDAD

Last Name

MASSOUMI-BAVIL

Suffix

Business Name

FARDAD MASSOUMI-BAVIL MD

Original Issue Date

03/25/2005

Effective Date

07/24/2008

Expiration Date

07/31/2011

City

MELROSE PARK

State

Zip

60160

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017