ENAYATOLLAH OSANLOO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

ENAYATOLLAH

Last Name

OSANLOO

Suffix

Business Name

ENAYATOLLAH OSANLOO MD

Original Issue Date

05/25/2004

Effective Date

06/02/2014

Expiration Date

07/31/2017

City

BOLINGBROOK

State

Zip

60440

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020