Indiana
Professional Licensing Agency
Kongiet Thaera
Controlled Substance Registration - Physician
License number
01029739B
Date granted
12/31/1985
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
1117 Killarney Drive, Dyer IN 46311
indianalicensing.org
ID 5844427
LAST UPDATED 2026-04-20 21:29:56 UTC
LAST UPDATED 2026-04-20 21:29:56 UTC
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