BHAVANA THOTA KANDIKATTU MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****58

License Status

ACTIVE

Business

First Name

BHAVANA

Middle

THOTA

Last Name

KANDIKATTU

Suffix

Business Name

BHAVANA THOTA KANDIKATTU MD

Original Issue Date

08/21/2008

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023