JISHANTH MATTUMPURAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148404

License Status

NOT RENEWED

Business

Title

First Name

JISHANTH

Last Name

MATTUMPURAM

Business Name

JISHANTH MATTUMPURAM MD

Original Issue Date

02/28/2019

Effective Date

06/10/2020

Expiration Date

07/31/2023

City

GREAT LAKES

State

Zip

60088

County

LAKE

Ever Disciplined

LastModifiedDate

11/30/2023