PADMA PONUGOTI MD

Business Entity
NOT RENEWED

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****90

NOT RENEWED

N

PADMA

PONUGOTI

MD

PADMA PONUGOTI MD

10/16/2001

10/16/2001

07/31/2005

ELGIN

IL

60123

KANE

II III IV V

N

10/09/2006