JAY R PUDUPAKKAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

JAY R

Last Name

PUDUPAKKAM

Suffix

Business Name

JAY R PUDUPAKKAM MD

Original Issue Date

07/16/1996

Effective Date

07/16/1996

Expiration Date

07/31/1999

City

OAK LAWN

State

Zip

60453

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006