VIDYA JAGANATH PUTHENVEETIL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

First Name

VIDYA

Middle

JAGANATH

Last Name

PUTHENVEETIL

Suffix

Business Name

VIDYA JAGANATH PUTHENVEETIL MD

Original Issue Date

12/31/2002

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

LAKE FOREST

State

Zip

60045

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021