SREENIVASA BASAVANTHAPPA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036163408

License Status

ACTIVE

Business

Title

First Name

SREENIVASA

Last Name

BASAVANTHAPPA

Business Name

SREENIVASA BASAVANTHAPPA MD

Original Issue Date

01/17/2023

Effective Date

04/27/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Ever Disciplined

LastModifiedDate

04/27/2023