BRANDON FORMAN DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

Title

First Name

BRANDON

Last Name

FORMAN

Business Name

BRANDON FORMAN DO

Original Issue Date

04/07/2024

Effective Date

04/07/2024

Expiration Date

07/31/2026

City

MELROSE PARK

State

Zip

60160

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026