SASIKANTH GORANTLA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

ACTIVE

Business

Title

First Name

SASIKANTH

Last Name

GORANTLA

Business Name

SASIKANTH GORANTLA MD

Original Issue Date

08/18/2015

Effective Date

04/12/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2023