SHANTA DEVI MATTAI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

ACTIVE

Business

First Name

SHANTA

Middle

DEVI

Last Name

MATTAI

Suffix

Business Name

SHANTA DEVI MATTAI MD

Original Issue Date

08/01/2005

Effective Date

04/25/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/25/2023