GNANESWARA V MIDATHALA 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

GNANESWARA V

Last Name

MIDATHALA

Business Name

GNANESWARA V MIDATHALA MD

Original Issue Date

03/21/1996

Effective Date

07/11/2011

Expiration Date

07/31/2014

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014