DIWAKAR T PULISETTY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

First Name

DIWAKAR

Middle

Last Name

PULISETTY

Suffix

Business Name

DIWAKAR T PULISETTY MD

Original Issue Date

11/29/2005

Effective Date

06/25/2008

Expiration Date

07/31/2011

City

EAST SAINT LOUIS

State

Zip

62201

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011