SASIDHARAN TARAVATH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

NOT RENEWED

Business

First Name

SASIDHARAN

Last Name

TARAVATH

Suffix

Business Name

SASIDHARAN TARAVATH MD

Original Issue Date

06/28/1990

Effective Date

06/28/1990

Expiration Date

07/31/1996

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006