AMITHA S MUSHYAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

Title

First Name

AMITHA

Middle

Last Name

MUSHYAM

Business Name

AMITHA S MUSHYAM MD

Original Issue Date

11/13/2014

Effective Date

06/08/2018

Expiration Date

09/30/2020

City

CRYSTAL LAKE

State

Zip

60014

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021