Indiana
Professional Licensing Agency
Median Ali
Controlled Substance Registration - Physician
License number
01057500B
Date granted
04/12/2004
Date expires
06/30/2009
Class
Controlled Substance Registration - Physician
Status
Expired
Address
301 Henry Street, North Vernon IN 47265
indianalicensing.org
ID 5907785
LAST UPDATED 2026-05-19 22:02:03 UTC
LAST UPDATED 2026-05-19 22:02:03 UTC
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