MANOJ SHIVSANKAR AMBALAVANAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077064

License Status

CANCELLED

Business

Title

First Name

MANOJ

Middle

SHIVSANKAR

Last Name

AMBALAVANAN

Business Name

MANOJ SHIVSANKAR AMBALAVANAN MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/01/2020