PHANICHARAN ADITYA SISTLA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

ACTIVE

Business

Title

First Name

PHANICHARAN

Middle

ADITYA

Last Name

SISTLA

Business Name

PHANICHARAN ADITYA SISTLA MD

Original Issue Date

04/29/2021

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

MAYWOOD

State

Zip

60153

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023