MANGA DEVI KODALI MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

CANCELLED

Business

First Name

MANGA

Middle

DEVI

Last Name

KODALI

Suffix

Business Name

MANGA DEVI KODALI MD

Original Issue Date

06/20/2001

Effective Date

06/20/2001

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006