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*****80

License Status

NOT RENEWED

Business

First Name

J S MANAKAVALAN

Last Name

PRABHAKAR

Suffix

Business Name

J S MANAKAVALAN PRABHAKAR MD

Original Issue Date

08/03/1990

Effective Date

08/03/1990

Expiration Date

07/31/1999

City

SYCAMORE

State

Zip

60178

County

DEKALB

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020