ATUL MEDAVARAM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

Title

First Name

ATUL

Last Name

MEDAVARAM

Business Name

ATUL MEDAVARAM MD

Original Issue Date

09/03/2022

Effective Date

06/29/2023

Expiration Date

07/31/2026

City

BOLINGBROOK

State

Zip

60440

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/29/2023