MARY LOUIS MANAVALAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058969

License Status

CANCELLED

Business

Title

First Name

MARY

Middle

LOUIS

Last Name

MANAVALAN

Business Name

MARY LOUIS MANAVALAN MD

Original Issue Date

08/23/2013

Effective Date

08/23/2013

Expiration Date

12/22/2014

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014