JITHINRAJ EDAKKANAMBETH VARAYIL 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

JITHINRAJ

Last Name

EDAKKANAMBETH VARAYIL

Business Name

JITHINRAJ EDAKKANAMBETH VARAYIL MD

Original Issue Date

09/25/2018

Effective Date

08/13/2020

Expiration Date

07/31/2023

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023