PRANITHA VIJAYA PRODDUTURVAR MD 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

Title

First Name

PRANITHA

Middle

VIJAYA

Last Name

PRODDUTURVAR

Business Name

PRANITHA VIJAYA PRODDUTURVAR MD

Original Issue Date

07/15/2009

Effective Date

07/15/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011