MANJU T POOVATHOOR 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

MANJU T

Last Name

POOVATHOOR

Business Name

MANJU T POOVATHOOR

Original Issue Date

02/19/2003

Effective Date

02/19/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60634

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006