VIDU BALA MOKKALA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053379

License Status

EXPIRED

Business

First Name

VIDU

Middle

BALA

Last Name

MOKKALA

Suffix

Business Name

VIDU BALA MOKKALA MD

Original Issue Date

06/16/2010

Effective Date

06/16/2010

Expiration Date

06/30/2010

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

07/08/2010