BERTRAM H NANAYAKKARA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

First Name

BERTRAM H

Last Name

NANAYAKKARA

Suffix

Business Name

BERTRAM H NANAYAKKARA MD

Original Issue Date

12/13/1983

Effective Date

04/18/2017

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021