GOUTHAM KONDAPI DO

Business Entity
ACTIVE

Medical Doctor

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

33*****96

ACTIVE

N

DO

GOUTHAM

KONDAPI

GOUTHAM KONDAPI DO

06/14/2022

06/09/2023

07/31/2026

EVERGREEN PARK

IL

60805

COOK

PRACTITIONER

II III IV V

N

06/09/2023