GANAPATHI R GOTTUMUKKALA Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

First Name

GANAPATHI R

Last Name

GOTTUMUKKALA

Business Name

GANAPATHI R GOTTUMUKKALA

Original Issue Date

08/04/1993

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

ORLAND PARK

State

Zip

60462

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/13/2023