SUMANA G KUMPUCKAL Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

SUMANA

Middle

Last Name

KUMPUCKAL

Business Name

SUMANA G KUMPUCKAL

Original Issue Date

11/26/2003

Effective Date

11/26/2003

Expiration Date

07/31/2005

City

DANVILLE

State

Zip

61832

County

VERMILION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020