NISHA GAJENDRA 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

Title

First Name

NISHA

Last Name

GAJENDRA

Business Name

NISHA GAJENDRA MD

Original Issue Date

08/02/2012

Effective Date

08/02/2012

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014