MALLIKARJUNA R KANNEGANTI Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

ACTIVE

Business

First Name

MALLIKARJUNA

Middle

Last Name

KANNEGANTI

Business Name

MALLIKARJUNA R KANNEGANTI

Original Issue Date

01/06/1989

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023