PRAVESH PRABHU DEOTALE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036135582

License Status

ACTIVE

Business

Title

First Name

PRAVESH

Middle

PRABHU

Last Name

DEOTALE

Business Name

PRAVESH PRABHU DEOTALE MD

Original Issue Date

06/19/2014

Effective Date

07/28/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63127

Ever Disciplined

LastModifiedDate

07/28/2023