AMIT SANTOSH DATE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

AMIT

Middle

SANTOSH

Last Name

DATE

Suffix

Business Name

AMIT SANTOSH DATE MD

Original Issue Date

07/08/2010

Effective Date

07/01/2020

Expiration Date

07/31/2023

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023