DIVYA MYADAM GUPTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

ACTIVE

Business

Title

First Name

DIVYA

Middle

MYADAM

Last Name

GUPTA

Business Name

DIVYA MYADAM GUPTA MD

Original Issue Date

07/03/2023

Effective Date

07/03/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/03/2023