THOMAS VENKAT MALLIDI Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060989

License Status

CANCELLED

Business

First Name

THOMAS

Middle

VENKAT

Last Name

MALLIDI

Business Name

THOMAS VENKAT MALLIDI

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

HINSDALE

State

Zip

60521

County

DUPAGE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

12/22/2014