SUPRIYA IMMANENI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073841

License Status

EXPIRED

Business

Title

First Name

SUPRIYA

Last Name

IMMANENI

Business Name

SUPRIYA IMMANENI MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2020

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

11/19/2020