GAUTAM D DESAI Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

GAUTAM D

Last Name

DESAI

Business Name

GAUTAM D DESAI

Original Issue Date

10/07/1988

Effective Date

10/07/1988

Expiration Date

07/31/1990

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006