BANDANA PATHAK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

NOT RENEWED

Business

Title

First Name

BANDANA

Last Name

PATHAK

Business Name

BANDANA PATHAK MD

Original Issue Date

06/12/2013

Effective Date

07/25/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021