AVANI GANTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

ACTIVE

Business

Title

First Name

AVANI

Last Name

GANTA

Business Name

AVANI GANTA MD

Original Issue Date

12/29/2022

Effective Date

07/13/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62769

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/13/2023