SHANTI P SUBBARAO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

ACTIVE

Business

First Name

SHANTI

Middle

Last Name

SUBBARAO

Business Name

SHANTI P SUBBARAO

Original Issue Date

09/29/2015

Effective Date

07/21/2023

Expiration Date

07/31/2026

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/21/2023