RAJU M MANTENA DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

RAJU

Middle

Last Name

MANTENA

Suffix

Business Name

RAJU M MANTENA DO

Original Issue Date

09/12/2012

Effective Date

09/12/2012

Expiration Date

07/31/2014

City

OAK PARK

State

Zip

60302

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

I II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014