NATHAN ANDREW MALL 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

Title

First Name

NATHAN

Middle

ANDREW

Last Name

MALL

Business Name

NATHAN ANDREW MALL MD

Original Issue Date

06/23/2011

Effective Date

06/23/2011

Expiration Date

07/31/2014

City

OAK PARK

State

Zip

60302

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014