EMAN MAZLOUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

NOT RENEWED

Business

Title

First Name

EMAN

Last Name

MAZLOUM

Business Name

EMAN MAZLOUM MD

Original Issue Date

06/02/2017

Effective Date

06/02/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021