KRISHNA KISHORE GADDAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

Title

First Name

KRISHNA

Middle

KISHORE

Last Name

GADDAM

Business Name

KRISHNA KISHORE GADDAM MD

Original Issue Date

09/12/2012

Effective Date

09/12/2012

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014