DIANE ANDAYA MADDELA DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000635

License Status

EXPIRED

Business

First Name

DIANE

Middle

ANDAYA

Last Name

MADDELA

Suffix

Business Name

DIANE ANDAYA MADDELA DO

Original Issue Date

09/03/2004

Effective Date

09/03/2004

Expiration Date

10/02/2004

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

Maternal-Fetal Medicine

Ever Disciplined

LastModifiedDate

09/25/2006