MIDHUN MALLA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

ACTIVE

Business

Title

First Name

MIDHUN

Last Name

MALLA

Business Name

MIDHUN MALLA MD

Original Issue Date

06/10/2025

Effective Date

06/10/2025

Expiration Date

07/31/2026

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/10/2025