PREMAL MADHUKAR TRIVEDI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

Title

First Name

PREMAL

Middle

MADHUKAR

Last Name

TRIVEDI

Business Name

PREMAL MADHUKAR TRIVEDI MD

Original Issue Date

09/28/2011

Effective Date

09/28/2011

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014