NIKESH RAVINDRAKUMAR LATH 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

NIKESH

Middle

RAVINDRAKUMAR

Last Name

LATH

Business Name

NIKESH RAVINDRAKUMAR LATH MD

Original Issue Date

06/24/2015

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023