MWIA ODESSA MUTUA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

ACTIVE

Business

Title

First Name

MWIA

Middle

ODESSA

Last Name

MUTUA

Business Name

MWIA ODESSA MUTUA MD

Original Issue Date

09/25/2018

Effective Date

05/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60649

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/07/2023