DIVYA PHANI MALLAMPATI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125066525

License Status

EXPIRED

Business

Title

First Name

DIVYA

Middle

PHANI

Last Name

MALLAMPATI

Business Name

DIVYA PHANI MALLAMPATI MD

Original Issue Date

06/23/2018

Effective Date

06/23/2018

Expiration Date

06/22/2019

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Obstetrics and Gynecology

Ever Disciplined

LastModifiedDate

10/02/2019