MATHEW J KALLOOKULANGARA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

First Name

MATHEW

Middle

Last Name

KALLOOKULANGARA

Business Name

MATHEW J KALLOOKULANGARA

Original Issue Date

04/09/2004

Effective Date

04/09/2004

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006