PUSHPA NAMBI JOSEPH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

PUSHPA

Middle

NAMBI

Last Name

JOSEPH

Suffix

Business Name

PUSHPA NAMBI JOSEPH MD

Original Issue Date

07/10/2000

Effective Date

07/10/2000

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006