SANJAY SURYAKANT PANCHOLI DO 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

First Name

SANJAY

Middle

SURYAKANT

Last Name

PANCHOLI

Suffix

Business Name

SANJAY SURYAKANT PANCHOLI DO

Original Issue Date

06/05/2007

Effective Date

05/08/2017

Expiration Date

09/30/2020

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021