MANISHA P KHATIWALA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

NOT RENEWED

Business

First Name

MANISHA

Middle

Last Name

KHATIWALA

Suffix

Business Name

MANISHA P KHATIWALA MD

Original Issue Date

11/05/2003

Effective Date

11/05/2003

Expiration Date

07/31/2008

City

DECATUR

State

Zip

62526

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008