BAVITHIRA ABIVARSHIA DEVASENATHIPATHY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

Title

First Name

BAVITHIRA

Middle

ABIVARSHIA

Last Name

DEVASENATHIPATHY

Business Name

BAVITHIRA ABIVARSHIA DEVASENATHIPATHY MD

Original Issue Date

01/08/2019

Effective Date

08/25/2020

Expiration Date

07/31/2023

City

EDWARDSVILLE

State

Zip

62025

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023