VENKATA SUSRUT PENDYALA 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

VENKATA

Middle

SUSRUT

Last Name

PENDYALA

Business Name

VENKATA SUSRUT PENDYALA MD

Original Issue Date

05/15/2019

Effective Date

05/15/2019

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