ASUNTA TIBURTIUS MODUTHAGAM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

ACTIVE

Business

Title

First Name

ASUNTA

Middle

TIBURTIUS

Last Name

MODUTHAGAM

Business Name

ASUNTA TIBURTIUS MODUTHAGAM MD

Original Issue Date

01/10/2011

Effective Date

06/14/2023

Expiration Date

07/31/2026

City

HUNTLEY

State

Zip

60142

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/14/2023