RAJU MAYAPA SHANMUGAM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

ACTIVE

Business

Title

First Name

RAJU

Middle

MAYAPA

Last Name

SHANMUGAM

Business Name

RAJU MAYAPA SHANMUGAM MD

Original Issue Date

03/14/2012

Effective Date

07/04/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/04/2023