BASAVA P ANCHA - Medical Doctor License in Illinois | # 125025686

BASAVA P ANCHA

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125025686

License Status

EXPIRED

Business

N

First Name

BASAVA

Middle

P

Last Name

ANCHA

Business Name

BASAVA P ANCHA

Original Issue Date

06/23/1990

Effective Date

06/23/1990

Expiration Date

06/24/1993

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006