VENKATESAN R GORANTLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

VENKATESAN R

Last Name

GORANTLA

Suffix

Business Name

VENKATESAN R GORANTLA MD

Original Issue Date

10/15/1991

Effective Date

10/15/1991

Expiration Date

07/31/2005

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006