MOANIS K H BASTAWROUS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

Title

First Name

MOANIS

Middle

K H

Last Name

BASTAWROUS

Business Name

MOANIS K H BASTAWROUS MD

Original Issue Date

05/10/2012

Effective Date

05/10/2012

Expiration Date

07/31/2014

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020