SIVAPRAGASAM SIVANESAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

First Name

SIVAPRAGASAM

Last Name

SIVANESAN

Business Name

SIVAPRAGASAM SIVANESAN

Original Issue Date

10/23/1991

Effective Date

10/23/1991

Expiration Date

07/31/1993

City

CHESTER

State

Zip

62233

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006