License holder summary

Kishore Raju Tara Patsamatla is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Kishore Raju Tara Patsamatla is 2754 LINCOLNWAY EAST, Mishawaka IN 46544. This licensed professional license is not current. The license was granted 08/20/2001 and expired on 06/30/2003.

Indiana

Professional Licensing Agency

Kishore Raju Tara Patsamatla
Controlled Substance Registration - Physician
License number
01054179B
Date granted
08/20/2001
Date expires
06/30/2003
Class
Controlled Substance Registration - Physician
Status
Expired
Address
2754 LINCOLNWAY EAST, Mishawaka IN 46544
indianalicensing.org
ID 5895432
LAST UPDATED 2026-06-12 17:21:04 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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