BANTI MAHANTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036056611

License Status

NOT RENEWED

Business

First Name

BANTI

Last Name

MAHANTA

Suffix

Business Name

BANTI MAHANTA MD

Original Issue Date

04/13/1978

Effective Date

04/30/2014

Expiration Date

07/31/2017

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

11/01/2017