BALAVITTAL VARANASI Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125027472

License Status

EXPIRED

Business

First Name

BALAVITTAL

Last Name

VARANASI

Business Name

BALAVITTAL VARANASI

Original Issue Date

08/05/1991

Effective Date

08/05/1991

Expiration Date

08/04/1993

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006