BEULAH JYOTHY KODURU 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

BEULAH

Middle

JYOTHY

Last Name

KODURU

Business Name

BEULAH JYOTHY KODURU

Original Issue Date

05/20/2019

Effective Date

05/20/2019

Expiration Date

09/30/2020

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021