PRAVEEN KANDULA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000638

License Status

EXPIRED

Business

First Name

PRAVEEN

Last Name

KANDULA

Suffix

Business Name

PRAVEEN KANDULA MD

Original Issue Date

10/11/2004

Effective Date

10/11/2004

Expiration Date

11/10/2004

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Nephrology

Ever Disciplined

LastModifiedDate

09/25/2006