FAZEEL MUKHTAR SIDDIQUI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

Title

First Name

FAZEEL

Middle

MUKHTAR

Last Name

SIDDIQUI

Business Name

FAZEEL MUKHTAR SIDDIQUI MD

Original Issue Date

03/11/2013

Effective Date

06/14/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021