SIVASANKER BAKTHAVACHALAM 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

SIVASANKER

Last Name

BAKTHAVACHALAM

Suffix

Business Name

SIVASANKER BAKTHAVACHALAM MD

Original Issue Date

08/16/2007

Effective Date

07/30/2008

Expiration Date

07/31/2011

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

PRACTITIONER

Ever Disciplined

LastModifiedDate

11/10/2011