TEJASWI SUMA DITTAKAVI DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074984

License Status

CANCELLED

Business

Title

First Name

TEJASWI

Middle

SUMA

Last Name

DITTAKAVI

Business Name

TEJASWI SUMA DITTAKAVI DO

Original Issue Date

06/24/2019

Effective Date

06/24/2019

Expiration Date

06/23/2022

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/09/2019