BALAVITTAL VARANASI Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036085451

License Status

INACTIVE

Business

First Name

BALAVITTAL

Last Name

VARANASI

Business Name

BALAVITTAL VARANASI

Original Issue Date

10/07/1992

Effective Date

07/21/2020

Expiration Date

07/31/2023

City

SHILOH

State

Zip

62221

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

03/06/2025