PRAVEEN KUMAR SAMPATH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

ACTIVE

Business

Title

First Name

PRAVEEN

Middle

KUMAR

Last Name

SAMPATH

Business Name

PRAVEEN KUMAR SAMPATH MD

Original Issue Date

05/20/2023

Effective Date

05/20/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61636

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/20/2023