BASAVA P ANCHA Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

ACTIVE

Business

First Name

BASAVA

Middle

Last Name

ANCHA

Business Name

BASAVA P ANCHA

Original Issue Date

12/04/1992

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

ORLAND PARK

State

Zip

60467

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023