MANJUSHA A GUPTE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

MANJUSHA

Middle

Last Name

GUPTE

Suffix

Business Name

MANJUSHA A GUPTE MD

Original Issue Date

10/26/2000

Effective Date

10/26/2000

Expiration Date

07/31/2005

City

PEORIA

State

Zip

61636

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006