GANGADHAR RAO MALASANA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

Title

First Name

GANGADHAR

Middle

RAO

Last Name

MALASANA

Business Name

GANGADHAR RAO MALASANA MD

Original Issue Date

06/08/2015

Effective Date

05/21/2020

Expiration Date

07/31/2023

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023