MANISH GUPTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

NOT RENEWED

Business

Title

First Name

MANISH

Last Name

GUPTA

Business Name

MANISH GUPTA MD

Original Issue Date

05/28/2015

Effective Date

06/10/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023