SHIVAPRASAD GOWDA MANJAPPA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054831

License Status

EXPIRED

Business

Title

First Name

SHIVAPRASAD

Middle

GOWDA

Last Name

MANJAPPA

Business Name

SHIVAPRASAD GOWDA MANJAPPA MD

Original Issue Date

06/16/2011

Effective Date

06/16/2011

Expiration Date

06/30/2011

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

07/19/2011