SURYA THEJA POLAVARAPU MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074374

License Status

CANCELLED

Business

Title

First Name

SURYA

Middle

THEJA

Last Name

POLAVARAPU

Business Name

SURYA THEJA POLAVARAPU MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

QUINCY

State

Zip

62301

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/29/2019