VIVEK S KANTAYYA 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

Title

First Name

VIVEK S

Last Name

KANTAYYA

Business Name

VIVEK S KANTAYYA MD

Original Issue Date

03/04/2014

Effective Date

04/23/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017