NIVRUTHI VANGALA 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

NIVRUTHI

Last Name

VANGALA

Business Name

NIVRUTHI VANGALA MD

Original Issue Date

03/05/2020

Effective Date

05/10/2023

Expiration Date

07/31/2026

City

CICERO

State

Zip

60804

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/10/2023