PRASANTA L BHAMIDIPATI Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

ACTIVE

Business

First Name

PRASANTA

Middle

Last Name

BHAMIDIPATI

Business Name

PRASANTA L BHAMIDIPATI

Original Issue Date

10/08/2010

Effective Date

07/25/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/25/2023