SURYA THEJA POLAVARAPU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

ACTIVE

Business

Title

First Name

SURYA

Middle

THEJA

Last Name

POLAVARAPU

Business Name

SURYA THEJA POLAVARAPU MD

Original Issue Date

08/11/2022

Effective Date

06/24/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62305

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/24/2023