SHASHI KEERTHAN MARYALA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080004

License Status

ACTIVE

Business

Title

First Name

SHASHI

Middle

KEERTHAN

Last Name

MARYALA

Business Name

SHASHI KEERTHAN MARYALA MD

Original Issue Date

06/26/2024

Effective Date

06/26/2024

Expiration Date

06/25/2026

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

10/01/2024