MAZEN BASSAM OMAR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

ACTIVE

Business

Title

First Name

MAZEN

Middle

BASSAM

Last Name

OMAR

Business Name

MAZEN BASSAM OMAR MD

Original Issue Date

08/14/2023

Effective Date

08/14/2023

Expiration Date

07/31/2026

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/14/2023