NIVEDITHA MUDEGOWDRA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

Title

First Name

NIVEDITHA

Last Name

MUDEGOWDRA

Business Name

NIVEDITHA MUDEGOWDRA MD

Original Issue Date

07/08/2019

Effective Date

07/08/2019

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021