THOMAS VENKAT MALLIDI Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

ACTIVE

Business

First Name

THOMAS

Middle

VENKAT

Last Name

MALLIDI

Business Name

THOMAS VENKAT MALLIDI

Original Issue Date

08/08/2014

Effective Date

04/16/2023

Expiration Date

07/31/2026

City

HINSDALE

State

Zip

60521

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/16/2023