IMMANUEL STEPHEN THAMBAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

First Name

IMMANUEL STEPHEN

Last Name

THAMBAN

Suffix

Business Name

IMMANUEL STEPHEN THAMBAN MD

Original Issue Date

01/11/1982

Effective Date

01/11/1982

Expiration Date

07/31/1993

City

DANVILLE

State

Zip

61832

County

VERMILION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011