License holder summary

Kannan Manickam is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Kannan Manickam is 1101 E Gelndale Blvd. Ste 111, Valparaiso IN 46383. This licensed professional license is not current. The license was granted 09/05/2003 and expired on 06/30/2011.

Indiana

Professional Licensing Agency

Kannan Manickam
Controlled Substance Registration - Physician
License number
01056563B
Date granted
09/05/2003
Date expires
06/30/2011
Class
Controlled Substance Registration - Physician
Status
Expired
Address
1101 E Gelndale Blvd. Ste 111, Valparaiso IN 46383
indianalicensing.org
ID 5928946
LAST UPDATED 2024-02-09 08:43:42 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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