KALYANI S VANGALA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

KALYANI

Middle

Last Name

VANGALA

Business Name

KALYANI S VANGALA

Original Issue Date

06/17/2022

Effective Date

06/17/2022

Expiration Date

07/31/2023

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023