MOHAMMAD REZA SHIRDEL GERDVISHEH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****78

License Status

NOT RENEWED

Business

Title

First Name

MOHAMMAD REZA

Middle

SHIRDEL

Last Name

GERDVISHEH

Business Name

MOHAMMAD REZA SHIRDEL GERDVISHEH MD

Original Issue Date

01/09/2019

Effective Date

09/22/2020

Expiration Date

07/31/2023

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023