AMBARISH MUKUND ATHAVALE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

AMBARISH

Middle

MUKUND

Last Name

ATHAVALE

Suffix

Business Name

AMBARISH MUKUND ATHAVALE MD

Original Issue Date

04/05/2011

Effective Date

06/17/2020

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023