VENKATASIVA R PERAM Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034801

License Status

CANCELLED

Business

First Name

VENKATASIVA

Middle

Last Name

PERAM

Business Name

VENKATASIVA R PERAM

Original Issue Date

05/30/1996

Effective Date

05/30/1996

Expiration Date

06/21/1999

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006