MITRA B BOODRAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

First Name

MITRA B

Last Name

BOODRAM

Suffix

Business Name

MITRA B BOODRAM MD

Original Issue Date

01/26/1993

Effective Date

01/26/1993

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020