SHIVA PRASAD GANGADHAR MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060175

License Status

EXPIRED

Business

First Name

SHIVA

Middle

PRASAD

Last Name

GANGADHAR

Suffix

Business Name

SHIVA PRASAD GANGADHAR MD

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2012

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

Transitional Year

Ever Disciplined

LastModifiedDate

08/29/2012