MAZEN KHERALLAH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

First Name

MAZEN

Last Name

KHERALLAH

Suffix

Business Name

MAZEN KHERALLAH MD

Original Issue Date

11/20/2018

Effective Date

04/29/2023

Expiration Date

07/31/2026

City

BURR RIDGE

State

Zip

60527

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/29/2023