KALUGOTLA N SHIVARAM Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

First Name

KALUGOTLA N

Last Name

SHIVARAM

Business Name

KALUGOTLA N SHIVARAM

Original Issue Date

08/09/1993

Effective Date

04/17/2023

Expiration Date

07/31/2026

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2023