MANISH CHANDRA MANDAVA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079921

License Status

EXPIRED

Business

Title

First Name

MANISH

Middle

CHANDRA

Last Name

MANDAVA

Business Name

MANISH CHANDRA MANDAVA MD

Original Issue Date

06/26/2022

Effective Date

06/26/2022

Expiration Date

06/25/2025

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

11/03/2025