VENKATA SUSRUT PENDYALA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

Title

First Name

VENKATA

Middle

SUSRUT

Last Name

PENDYALA

Business Name

VENKATA SUSRUT PENDYALA MD

Original Issue Date

06/30/2015

Effective Date

06/30/2015

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020