MANOJ SHIVSANKAR AMBALAVANAN MD - Medical Doctor License in Illinois | # 125077064

MANOJ SHIVSANKAR AMBALAVANAN MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077064

License Status

CANCELLED

Business

N

Title

MD

First Name

MANOJ

Middle

SHIVSANKAR

Last Name

AMBALAVANAN

Business Name

MANOJ SHIVSANKAR AMBALAVANAN MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

05/01/2020