FORTESA MYHA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****34

License Status

ACTIVE

Business

First Name

FORTESA

Last Name

MYHA

Business Name

FORTESA MYHA

Original Issue Date

09/14/2017

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

WOOD DALE

State

Zip

60191

County

DUPAGE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025