ANAND VENKAT MANTRAVADI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

NOT RENEWED

Business

First Name

ANAND

Middle

VENKAT

Last Name

MANTRAVADI

Suffix

Business Name

ANAND VENKAT MANTRAVADI MD

Original Issue Date

01/17/2008

Effective Date

07/28/2008

Expiration Date

07/31/2011

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011