MAN SUBHASIRIWATANA MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048859

License Status

INACTIVE

Business

First Name

MAN

Last Name

SUBHASIRIWATANA

Suffix

Business Name

MAN SUBHASIRIWATANA MD

Original Issue Date

02/05/1974

Effective Date

02/05/1974

Expiration Date

07/31/1987

City

CROWN POINT

State

Zip

46307

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006