SAMYUKTA KOPPULA Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

ACTIVE

Business

First Name

SAMYUKTA

Last Name

KOPPULA

Business Name

SAMYUKTA KOPPULA

Original Issue Date

01/17/1989

Effective Date

07/14/2023

Expiration Date

07/31/2026

City

WILLOWBROOK

State

Zip

60527

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/14/2023