VENKATA SUSRUT PENDYALA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036138524

License Status

NOT RENEWED

Business

Title

First Name

VENKATA

Middle

SUSRUT

Last Name

PENDYALA

Business Name

VENKATA SUSRUT PENDYALA MD

Original Issue Date

06/30/2015

Effective Date

06/26/2017

Expiration Date

09/30/2020

City

PEORIA HEIGHTS

State

Zip

61616

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/14/2021