SREENIVASA BASAVANTHAPPA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

Title

First Name

SREENIVASA

Last Name

BASAVANTHAPPA

Business Name

SREENIVASA BASAVANTHAPPA MD

Original Issue Date

03/09/2023

Effective Date

04/27/2023

Expiration Date

07/31/2026

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/27/2023