HAMSAVENI K JAGANNATHAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

First Name

HAMSAVENI K

Last Name

JAGANNATHAN

Suffix

Business Name

HAMSAVENI K JAGANNATHAN MD

Original Issue Date

01/01/1997

Effective Date

06/14/2017

Expiration Date

09/30/2020

City

GALESBURG

State

Zip

61401

County

KNOX

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021