VIVEK S KANTAYYA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125021949

License Status

EXPIRED

Business

Title

First Name

VIVEK S

Last Name

KANTAYYA

Business Name

VIVEK S KANTAYYA MD

Original Issue Date

05/05/1988

Effective Date

05/05/1988

Expiration Date

07/01/1991

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006