BONEY MATTATHETHU NINAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

Title

First Name

BONEY

Middle

MATTATHETHU

Last Name

NINAN

Business Name

BONEY MATTATHETHU NINAN MD

Original Issue Date

08/20/2013

Effective Date

04/14/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60607

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017