SURYA THEJA POLAVARAPU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036161586

License Status

ACTIVE

Business

Title

First Name

SURYA

Middle

THEJA

Last Name

POLAVARAPU

Business Name

SURYA THEJA POLAVARAPU MD

Original Issue Date

07/21/2022

Effective Date

04/22/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

Ever Disciplined

LastModifiedDate

04/22/2023