MANASA G MANTRAVADI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056687

License Status

EXPIRED

Business

First Name

MANASA

Middle

Last Name

MANTRAVADI

Suffix

Business Name

MANASA G MANTRAVADI MD

Original Issue Date

06/23/2009

Effective Date

06/23/2009

Expiration Date

06/22/2012

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

08/29/2012