ANNESLEY T DE VASGUNAWARDHANE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

First Name

ANNESLEY T DE

Last Name

VASGUNAWARDHANE

Suffix

Business Name

ANNESLEY T DE VASGUNAWARDHANE MD

Original Issue Date

09/09/1996

Effective Date

09/09/1996

Expiration Date

07/31/1999

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011