SUMANA G KUMPUCKAL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

First Name

SUMANA

Middle

Last Name

KUMPUCKAL

Business Name

SUMANA G KUMPUCKAL

Original Issue Date

10/24/2003

Effective Date

05/25/2023

Expiration Date

07/31/2026

City

DANVILLE

State

Zip

61832

County

VERMILION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/25/2023