ANASUYA S BRAHMAMDAM - Medical Doctor License in Illinois | # 125056501

ANASUYA S BRAHMAMDAM

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056501

License Status

CANCELLED

Business

N

First Name

ANASUYA

Middle

S

Last Name

BRAHMAMDAM

Business Name

ANASUYA S BRAHMAMDAM

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

04/14/2009