SHYAM KIRAN GANDAM-VENKATA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

ACTIVE

Business

Title

First Name

SHYAM KIRAN

Last Name

GANDAM-VENKATA

Business Name

SHYAM KIRAN GANDAM-VENKATA MD

Original Issue Date

05/31/2017

Effective Date

05/29/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/29/2023