FAIROUZ C CODINA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

Title

First Name

FAIROUZ

Middle

Last Name

CODINA

Business Name

FAIROUZ C CODINA MD

Original Issue Date

10/17/2011

Effective Date

07/18/2014

Expiration Date

07/31/2017

City

CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020