SURAJ BOPANNA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

ACTIVE

Business

First Name

SURAJ

Last Name

BOPANNA

Suffix

Business Name

SURAJ BOPANNA MD

Original Issue Date

08/10/2010

Effective Date

05/17/2023

Expiration Date

07/31/2026

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/17/2023