MOSTAFA MACIDA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

MOSTAFA

Last Name

MACIDA

Suffix

Business Name

MOSTAFA MACIDA MD

Original Issue Date

07/06/2010

Effective Date

04/05/2011

Expiration Date

07/31/2014

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020