PRAVEJ ITARUT MD

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****15

NOT RENEWED

N

PRAVEJ

ITARUT

MD

PRAVEJ ITARUT MD

01/01/1997

04/17/2008

07/31/2011

NASHVILLE

IL

62263

WASHINGTON

II III IV V

N

11/10/2011