J S MANAKAVALAN PRABHAKAR 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

J S MANAKAVALAN

Last Name

PRABHAKAR

Suffix

Business Name

J S MANAKAVALAN PRABHAKAR MD

Original Issue Date

01/01/1997

Effective Date

10/23/2017

Expiration Date

09/30/2020

City

ROCHELLE

State

Zip

61068

County

OGLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021