MUMTAZ U ZAMAN

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****80

NOT RENEWED

N

MUMTAZ U

ZAMAN

MUMTAZ U ZAMAN

10/17/1996

10/17/1996

07/31/2002

CHICAGO

IL

60614

COOK

II

N

10/09/2006