SUBBIA GOUNDAR JAGANNATHAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

First Name

SUBBIA

Middle

GOUNDAR

Last Name

JAGANNATHAN

Suffix

Business Name

SUBBIA GOUNDAR JAGANNATHAN MD

Original Issue Date

03/03/1998

Effective Date

06/02/2014

Expiration Date

07/31/2017

City

GALESBURG

State

Zip

61401

County

KNOX

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020