SHRAVANA DEEPTHI GUDIVADA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068551

License Status

EXPIRED

Business

Title

First Name

SHRAVANA

Middle

DEEPTHI

Last Name

GUDIVADA

Business Name

SHRAVANA DEEPTHI GUDIVADA MD

Original Issue Date

06/26/2016

Effective Date

06/26/2016

Expiration Date

06/25/2019

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/02/2019