MAIMANAT A NIZAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

First Name

MAIMANAT A

Last Name

NIZAM

Suffix

Business Name

MAIMANAT A NIZAM MD

Original Issue Date

03/26/1985

Effective Date

10/04/2017

Expiration Date

09/30/2020

City

BURR RIDGE

State

Zip

60527

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021