POONAM LAKSHMI KAZA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

NOT RENEWED

Business

Title

First Name

POONAM

Middle

LAKSHMI

Last Name

KAZA

Business Name

POONAM LAKSHMI KAZA MD

Original Issue Date

06/22/2017

Effective Date

06/22/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

01/14/2021