HARITHA BELLAM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

First Name

HARITHA

Last Name

BELLAM

Business Name

HARITHA BELLAM

Original Issue Date

09/16/2010

Effective Date

09/16/2010

Expiration Date

07/31/2011

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011