VIVEK S KANTAYYA MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036081072

License Status

INACTIVE

Business

Title

First Name

VIVEK S

Last Name

KANTAYYA

Business Name

VIVEK S KANTAYYA MD

Original Issue Date

07/19/1990

Effective Date

04/23/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/11/2017