ANASUYA S BRAHMAMDAM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

ANASUYA

Middle

Last Name

BRAHMAMDAM

Business Name

ANASUYA S BRAHMAMDAM

Original Issue Date

03/07/2012

Effective Date

04/24/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017