GENESIS T MANCHA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

ACTIVE

Business

Title

First Name

GENESIS

Middle

Last Name

MANCHA

Business Name

GENESIS T MANCHA MD

Original Issue Date

07/24/2023

Effective Date

07/24/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2023