AVANI GANTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036162837

License Status

ACTIVE

Business

Title

First Name

AVANI

Last Name

GANTA

Business Name

AVANI GANTA MD

Original Issue Date

11/05/2022

Effective Date

05/17/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/17/2023