SHWETHA MALLESARA SUDHAKAR 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

Title

First Name

SHWETHA

Last Name

MALLESARA SUDHAKAR

Business Name

SHWETHA MALLESARA SUDHAKAR MD

Original Issue Date

03/28/2012

Effective Date

03/28/2012

Expiration Date

07/31/2014

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014