MANIDEEP DUTTULURI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

ACTIVE

Business

Title

First Name

MANIDEEP

Last Name

DUTTULURI

Business Name

MANIDEEP DUTTULURI MD

Original Issue Date

05/13/2022

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63141

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2023