NISHA GAJENDRA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057742

License Status

CANCELLED

Business

Title

First Name

NISHA

Last Name

GAJENDRA

Business Name

NISHA GAJENDRA MD

Original Issue Date

06/26/2010

Effective Date

06/26/2010

Expiration Date

06/25/2013

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/20/2010