MARDJAN FOROUTAN 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

First Name

MARDJAN

Last Name

FOROUTAN

Suffix

Business Name

MARDJAN FOROUTAN MD

Original Issue Date

06/27/2011

Effective Date

06/27/2011

Expiration Date

07/31/2014

City

SYCAMORE

State

Zip

60178

County

DEKALB

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020