VENKATA SUSRUT PENDYALA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061420

License Status

CANCELLED

Business

Title

First Name

VENKATA

Middle

SUSRUT

Last Name

PENDYALA

Business Name

VENKATA SUSRUT PENDYALA MD

Original Issue Date

06/26/2012

Effective Date

06/26/2012

Expiration Date

06/25/2015

City

SRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014