BANTI MAHANTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****78

License Status

NOT RENEWED

Business

First Name

BANTI

Last Name

MAHANTA

Suffix

Business Name

BANTI MAHANTA MD

Original Issue Date

01/18/1989

Effective Date

04/30/2014

Expiration Date

07/31/2017

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017