MANOJ SHIVSANKAR AMBALAVANAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

ACTIVE

Business

Title

First Name

MANOJ

Middle

SHIVSANKAR

Last Name

AMBALAVANAN

Business Name

MANOJ SHIVSANKAR AMBALAVANAN MD

Original Issue Date

08/29/2022

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023