MITRA B BOODRAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

MITRA B

Last Name

BOODRAM

Suffix

Business Name

MITRA B BOODRAM MD

Original Issue Date

08/17/1998

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

MARION

State

Zip

62959

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021