TANVI HATHIWALA MUKUNDAN 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

Title

First Name

TANVI

Middle

HATHIWALA

Last Name

MUKUNDAN

Business Name

TANVI HATHIWALA MUKUNDAN MD

Original Issue Date

06/09/2017

Effective Date

06/09/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021