GAYATHRI N MANICKAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

Title

First Name

GAYATHRI

Middle

Last Name

MANICKAM

Business Name

GAYATHRI N MANICKAM MD

Original Issue Date

07/30/2009

Effective Date

07/30/2009

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60661

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011