BALA V MANYAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

First Name

BALA V

Last Name

MANYAM

Suffix

Business Name

BALA V MANYAM MD

Original Issue Date

11/16/1984

Effective Date

11/16/1984

Expiration Date

07/31/1999

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006