VENKATESAN R GORANTLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036083427

License Status

NOT RENEWED

Business

First Name

VENKATESAN R

Last Name

GORANTLA

Suffix

Business Name

VENKATESAN R GORANTLA MD

Original Issue Date

09/10/1991

Effective Date

09/10/1991

Expiration Date

07/31/2005

City

LIBERTY TOWNSHIP

State

Zip

45011

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

04/29/2012