MARY LOUIS MANAVALAN 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

MARY

Middle

LOUIS

Last Name

MANAVALAN

Business Name

MARY LOUIS MANAVALAN MD

Original Issue Date

05/09/2014

Effective Date

05/09/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017