SHANTHA K MONIPPALLIL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

SHANTHA

Middle

Last Name

MONIPPALLIL

Suffix

Business Name

SHANTHA K MONIPPALLIL MD

Original Issue Date

01/01/1997

Effective Date

06/10/2014

Expiration Date

07/31/2017

City

CHARLESTON

State

Zip

61920

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020