MANASA KANDULA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

ACTIVE

Business

Title

First Name

MANASA

Last Name

KANDULA

Business Name

MANASA KANDULA MD

Original Issue Date

05/31/2017

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

04/11/2023