KALYAN CHAKRAVARTHY POTU MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067981

License Status

CANCELLED

Business

Title

First Name

KALYAN

Middle

CHAKRAVARTHY

Last Name

POTU

Business Name

KALYAN CHAKRAVARTHY POTU MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

SPRINGFIELD

State

Zip

62711

County

PEORIA

Specialty/Qualifier

Cardiovascular Disease

Ever Disciplined

LastModifiedDate

03/15/2016