PRASANNA VENKATESH KUMAR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036112319

License Status

NOT RENEWED

Business

First Name

PRASANNA

Middle

VENKATESH

Last Name

KUMAR

Suffix

Business Name

PRASANNA VENKATESH KUMAR MD

Original Issue Date

09/13/2004

Effective Date

05/12/2011

Expiration Date

07/31/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

11/17/2014