BALAVITTAL VARANASI Medical Doctor License verification

Business Entity

INOPERATIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

INOPERATIVE

Business

First Name

BALAVITTAL

Last Name

VARANASI

Business Name

BALAVITTAL VARANASI

Original Issue Date

05/12/1993

Effective Date

08/10/2023

Expiration Date

07/31/2026

City

CENTRALIA

State

Zip

62801

County

MARION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/10/2023