REVATHI SUPPIAH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

First Name

REVATHI

Last Name

SUPPIAH

Suffix

Business Name

REVATHI SUPPIAH MD

Original Issue Date

07/15/2008

Effective Date

04/29/2023

Expiration Date

07/31/2026

City

ZION

State

Zip

60099

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/29/2023